Inflatable medical devices

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims priority to U.S. Provisional Application Nos. 61/057,986, filed 2 Jun. 2008; 61/086,739, filed 6 Aug. 2008; 61/105,385, filed 14 Oct. 2008; and 61/205,866, filed 22 Jan. 2009 which are incorporated by reference herein in their entireties.

BACKGROUND OF THE INVENTION

1. Field of the Invention

This invention relates to inflatable structures for use in medicine and other applications, and methods of manufacture and use of the same.

2. Description of the Related Art

Inflatable structures, such as balloons, are widely used in medical procedures. A balloon is inserted, typically on the end of a catheter, until the balloon reaches the area of interest. Adding pressure to the balloon causes the balloon to inflate. In one variation of use, the balloon creates a space inside the body when the balloon inflates.

Balloons may be used to move plaque away from the center of a vascular lumen toward the vasculature walls, such as during an angioplasty or a peripheral vasculature procedure. During this procedure, a balloon tipped catheter is placed in a vascular obstruction. As the balloon is inflated, the vessel constriction is dilated, resulting in improved blood flow.

Optionally, the balloon may have a stent placed over it. The balloon expands the stent in order to create a scaffold structure that keeps the vessel from constricting after the balloon is removed. Stents are used throughout the body, including the coronaries, other portions of the vasculature, the GI tract, the biliary ducts and the urinary and gynecologic tracts.

High pressure balloons may be used to expand constrictions in bone, such as in the sinuses in sinuplasty.

Balloons may be designed to make space in bone. After an osteoporotic compression or trauma-induced fracture in a vertebral body, a balloon can be inserted into the vertebral body through a working channel such as a cannula. The balloon is then inflated, creating a void in the bone. The balloon is withdrawn and bone cement is injected to internally stabilize the fracture. This procedure may be referred to as Kyphoplasty.

Sometimes the vasculature has a narrowing that is calcified, which can create a particularly difficult obstruction for dilation. As the vessel is increasingly narrowed, it can become what is known as a CTO (Chronic Total Occlusion). CTOs can be difficult to pass through with a device such as a guidewire or catheter and can be difficult to dilate or open. The balloon used to open a CTO is ideally resistant to puncture and operates at a very high pressure.

Balloons can have structures attached to their surface. These structures can include blades or stiffening rods. These structures may slice a vessel open. These structures may apply pressure to the inside of a vessel in order to expand the vessel.

Balloons can be used to locally deliver captured volumes of a radioactive substance. The procedure may be known as brachytherapy.

Balloons can be used to intentionally obstruct vessels. Stenting of the carotids serves to treat atherosclerotic carotid vessels. Stenting of the carotids may be less invasive than an endarterectomy. Stenting of the carotids may release a stream of debris that can travel to the brain, causing strokes. Expanding a balloon in the carotid artery above the area of treatment can prevent this debris movement to the brain, thereby reducing the potential for adverse complications.

Balloons may be used to position and deploy arterial grafts that repair aneurysms.

A balloon may deliver targeted drugs in the body by isolating a space for treatment.

A balloon may deliver targeted drugs in the body by having many tiny holes in the balloon wall. The holes in the balloon wall may allow the drug to slowly flow into the area surrounding the balloon.

Balloons may be used endoscopically to open up constrictions in the body, such as those in the esophageal tract, the urological tract, the biliary tract, the fallopian tubes, the carpal tunnel or esophagus, or other portions of the GI tract (the alimentary canal). A balloon may be used to expand constrictions in the urethra, including for Benign Prostate Hyperplasia (BPH).

Balloons may be used in the heart valves, including during Percutaneous Transvenous Mitral Valvuloplasty (PTMV) or Percutaneous Transvenous Mitral Balloon Commissurotomy (PTMC) or Mitral Annuloplasty. The balloons can be utilized to expand stenosed or calcifically-narrowed structures. The balloons can be utilized to expand valves to a tissue-opposed diameter.

A balloon may be used to affix a device inside the body. Another device may then use the balloon as a structure that the device can react against. The device may use this reaction force to move in the body. A balloon and a device may be used in the GI tract. A balloon and a device may be used during a Double Balloon Enteroscopy procedure, or during colonoscopy.

Balloons may be used to create space in the body or to move organs in body. Balloons can be used to manipulate organs along tissue planes.

The balloon may locate a cutting instrument in some ablative procedures. The balloon may position a diagnostic device.

An inflatable structure can be used to open space in tissue or to pull sclerotic structures apart, or to advance structures introduced herewithin to the body.

A balloon may be used to occupy a volumetric space for long periods of time, such as a device used to impart satiety at lower food volumes, as in Bariatric procedures.

A balloon can be used to create captured volumes that serve to transfer heat or cold. A balloon can provide small crossing profiles that then expand locally to create large volumes with high surface areas and intimate tissue contact. This is utilized in the prostate to treat BPH.

Balloons can be used as implants, creating an anatomical conforming structure advantageous to improved local fit.

Balloons have been suggested which seal against a lumen wall, then continue to dynamically seal as they are manipulated backwards or forwards. These balloons may be used in the GI tract. These balloons may be advanced forward or backward by pressure gradients on either side of the balloon.

Balloons may be used as pressure cuffs, such as those found in Lap-Band bariatric devices. By changing the pressure in the balloon, the inner diameter can grow or shrink. Changing the diameter alters clinical results.

Balloons may be elongated and used for movement through long lumens, including the GI tract.

Inflatable structures can be made into everting tubes, which have been utilized in gynecologic and urinary procedures, and have been suggested for GI procedures.

Two basic types of balloons are utilized: One is a high pressure, low-compliance balloon. The other is a lower pressure, high-compliance balloon.

High-compliance medical balloons are often composed of urethane, latex, silicone, PVC, Pebax, and other elastomers. As the pressure in a high-compliant balloon is increased, the balloon dimensions expand. Once the pressure is reduced, the high-compliance medical balloon may return to its original shape, or near its original shape. High-compliance medical balloons can easily expand several times in volume between zero inflation pressure and burst.

Traditional high-compliance medical balloons can be inadequate for many reasons. High-compliance, or highly elastic medical balloons typically cannot reach high pressures because their walls have a low tensile strength and their walls thin out as the balloon expands. In some instances, high-compliance medical balloons provide insufficient force to complete a procedure. Exceeding the rated pressure of a high-compliance medical balloon creates an excessive risk of balloon failure which can lead to serious complications for the patient.

High-compliance medical balloons also have poor shape control. As a high-compliance medical balloon expands, it may assume a shape dictated mostly by the particulars of the environment inside the patient rather than the clinical goals. In some cases, this can be contrary to what the medical practitioner desires. Many medical procedures are predicated on forming a particular balloon shape reliably.

High-compliance medical balloons often suffer from poor puncture resistance.

It is generally desirable that the medical balloon be able to enter and exit the body with as little trauma as possible. Therefore, a small deflated balloon profile is an important consideration in balloon design. This requirement favors materials with high strength to volume ratios. High-compliance medical balloons do not use materials that have outstanding strength to volume ratios.

In some cases, it is desirable that the medical balloon have a strong chemical resistance. For instance, a principal component of bone cement is methyl methacrylate, which readily degrades some elastomers, such as urethane. Therefore, many high-compliance medical balloons are not compatible with the introduction of aspects of the procedure that the high-compliance medical balloon is meant to support.

Low-compliance, high pressure medical balloons substantially retain their shape under comparatively high pressures. PET (polyethylene terephthalate) is the most common material for use in high pressure low-compliance balloons. PET is commonly used for high-performance angioplasty balloons. PET is stronger than other polymers, can be molded into a variety of shapes and can be made very thin (e.g., 5 μm to 50 μm (0.0002 in. to 0.002 in.)), thus giving these balloons a low profile.

Balloons made from PET walls are fragile and prone to tears. When pressed against a hard or sharp surface in the body, such as bone, PET balloons have poor puncture resistance. PET is very stiff so balloons made from PET may be difficult to pack or fold into a small diameter or with good trackability (i.e., the ability to slide and bend over a guidewire deployed through a tortuous vessel). In some applications, PET's chemical resistance can lead to unwanted adhesion, degradation or destruction of a PET balloon during a procedure.

Balloons made from PET, while stronger than most other balloons made from homogenous polymers, may still not be strong enough to hold pressures sufficient to complete certain medical procedures.

The PET in a balloon wall may be oriented during manufacture. However, the oriented PET may not have strength in all directions exactly proportionate to the expected load.

PET, like most low compliance balloons, is usually blow-molded. The blow molding process makes it difficult or impossible to create certain shapes. Blow molding can result in wall thicknesses in the balloon that do not match the material thicknesses to the expected load.

Nylon balloons are an alternative material for low-compliance, high pressure balloons. These balloons are typically weaker than PET balloons and so can contain less pressure. Nylon readily absorbs water, which can have an adverse affect on Nylon's material properties in some circumstances. Nylon has improved puncture resistance over PET and is more flexible than PET.

Low compliance fiber reinforced medical balloons have recently become commercially available for peripheral vascular procedures. High strength inelastic fibers are used as part of the low compliance fiber reinforced medical balloons to strengthen the walls of the balloon while further lowering strain rates. High strength inelastic fibers such as Kevlar, Vectran, Dyneema and carbon fiber all have strength to volume ratios that greatly exceed that of PET or Nylon. The high strength inelastic fibers are combined with a flexible adhesive and, optionally, one or more polymer walls to form a balloon.

Low compliance fiber reinforced medical balloons may suffer from several problems. These balloons may have a low volume ratio of high strength inelastic fiber to the total material volume in the balloon walls. It is reasonable to assume that a higher volume ratio of high strength inelastic fiber to the total material volume in the balloon walls would lead to a higher burst pressure for the same wall thickness.

Commercially available low compliance fiber reinforced medical balloons and the processes that produce them may only allow limited flexibility in the placement of the high strength inelastic fibers. For example, a process may result in fibers aligned along the axis of the balloon and fibers wrapped around the circumference. This limited choice of fiber orientation is not always the optimum way to orient the fibers for maximum strength. This limited choice of fiber orientation is not always the optimum way to orient fibers to resist puncture or ripping.

Commercially available low compliance fiber reinforced medical balloons and the processes that produce them may not allow for a large variety of different balloon shapes to be manufactured.

SUMMARY OF THE INVENTION

Medical inflatable devices for use in a biological body are disclosed. The device can have a balloon. The balloon can have a wall having an inner layer, a first middle layer, and an outer layer. The outer layer can be thinner than about 0.05 mm (0.002 in.), and the inner layer is thinner than about 0.05 mm (0.002 in.). The first middle layer can have a fiber. The outer layer can have a melt or decomposition temperature greater than about 200° Celsius.

The outer layer can be made from a thermoset material. The outer layer can be made from PEEK. The outer layer can be made from a polyamide. The outer layer can be methylmethacrylate (MMA)-resistant and/or MMA-releasing. An MMA-resistant layer can be substantially non-degrading when exposed to MMA, such as uncured MMA. An MMA-releasing layer can be substantially non-binding or non-adhering to MMA. The MMA-releasing layer can be pulled away and separated from cured MMA without binding to the MMA.

The first middle layer can be made from a resin. The inner layer can be thinner than about 0.01 mm (0.0004 in.), and the outer layer can be thinner than about 0.01 mm (0.0004 in.). The inner layer can be substantially air leak-proof.

The balloon can have a wall that can have an inner layer, a first middle layer, and an outer layer.

The outer layer can be thinner than about 0.05 mm (0.002 in.). The outer layer can have a thermoset material, such as PEEK. The outer layer can have a polyamide. The first middle layer can have a fiber and/or a resin.

The wall can have an air leak-proof inner layer and an MMA-resistant outer layer. The outer layer can be thinner than about 0.05 mm (0.002 in.), and the inner layer can be thinner than about 0.05 mm (0.002 in.).

The second layer can be radially inside the third layer, and the second layer can be radially outside the first layer. The third layer can make up the radial outermost surface of the wall. The wall can also have a fourth layer. The fourth layer can be radially inside the third layer. The fourth layer can be radially outside the first layer. The fourth layer can have a radiopaque material.

The wall can have a first layer, a second layer, a third layer, and a fourth layer. The first layer can be leak-proof and the fourth layer is MMA-resistant. The first layer can be radially inside of the second layer, the third layer, and the fourth layer. The fourth layer can be radially outside of the first layer, the second layer, and the third layer. One, two, or three layers can have resin and fiber in contact with the resin, for example the fiber can be embedded within the resin or in one side of the resin. The layers with the fiber can be MMA-resistant.

The wall can have a layer that can form at least one continuous seam around the balloon. The balloon can be substantially non-compliant or inelastic. The wall can be less than about 0.1 mm (0.004 in.) thick.

The balloon can have a longitudinal axis having a longitudinal axis length. The balloon can have a fiber having a fiber length. The fiber length can be about 175% to about 300% of the longitudinal axis length. The wall of the balloon can have a first layer and a second layer. The fiber can be in the second layer. The first layer can be on the radial inside of the fiber with respect to the balloon, and the first layer can be leak-proof, and/or MMA-resistant.

The balloon can have an inner diameter of more than about 2 mm, or about 13 mm (0.5 in.), or more than about 15 mm. The balloon can have a wall having a wall thickness of less than about 0.005 in., and a burst pressure greater than about 150 psi, more narrowly greater than about 3,400 kPa (500 psi). For example, the burst pressure of the balloon can be greater than about 2,100 kPa (300 psi).

The balloon can have a proximal terminal end and a distal terminal end. The balloon can have a closed distal terminal end, or no through-lumen. Having no through-lumen can include having no longitudinal through-lumen extending through the proximal terminal end and through the distal terminal end. The distal end of the balloon can be atraumatic, for example blunt.

The balloon can have a reinforcement fiber that can be in a matrix. The matrix can have a reinforcement fiber and a resin. The resin can be an adhesive. The fibers can be oriented longitudinally and/or around the distal end of the balloon. The fibers can cover (but not necessarily on the outer surface) greater than 50% of the area of the balloon wall. The matrix can have a thermoplastic material.

The balloon wall can have a first, second and/or more strips. The strips can have none, one or more reinforcement and/or radiopaque marker fibers. Each strip can have the same or a different number of fibers. The balloon can have a closed distal end. The first strip can overlay the second strip at the distal end. Additional strips can overlay the first and second strips at the distal end or elsewhere along the length of the balloon. The strips can intersect at a strip angle. The strip angle can be equal to or greater than about 30 or 45 degrees. For example, the strip angle can be about 60 degrees or about 90 degrees.

The first middle layer can have a radiopaque material and be substantially contiguous throughout the wall. For example, the first middle layer can have a metal foil. The first middle layer can have a radiopaque material in non-powder form. The first middle layer can have less than about 100 pieces of radiopaque material. The radiopaque material can covers (not necessarily on the top surface) at least about 30% of the area of the wall of the balloon. The first middle layer can have a first elongated member that can have a radiopaque material. For example, the elongate member can be a strip, such as the strip described herein.

The first middle layer can have a fiber. The second middle layer can have a radiopaque material. The first middle layer can be between the inner layer and the second middle layer.

The balloon wall can have a water-proof inner layer, a first middle layer that can have a fiber, a second middle layer that can have a radiopaque wire, and an outer layer. The fiber can be helically positioned or hoop or helically wrapped around the balloon wall.

The radially outer layer of the balloon wall can have a thickness of less than about 0.0005 in. and the radially outer layer can be resistant to degradation by MMA. The radially outer layer can be made from or coated with Teflon or PTFE. The MMA-resistant layer can have an MMA-resistant matrix and a fiber. The MMA-resistant matrix can have an adhesive. The balloon can be configured to deliver a radial pressure of about 2,800 kPa (400 psi).

The balloon can be shaped having a first side and a second side. The first side can be opposite the second side with respect to the balloon longitudinal axis. The first side can be substantially flat, and the second side can be substantially flat.

The balloon wall can have a wall thickness of equal to or less than about 0.3 mm, for example about 0.1 mm, and the balloon has an outer diameter less than or equal to about 13 mm, and the balloon has a burst pressure of equal to or greater than about 1000 kPa (150 psi).

The balloon wall can have a first layer that can have a reinforcement and/or marker fiber and a second layer that can have a resistive heating element, such as tantalum foil. The resistive heating element can be a wire helically configured around the balloon. The resistive heating element can be controlled by a controller configured to controllably deliver energy to the resistive heating element. The resistive heating material can be the elongated strip or in the elongated strip.

The wall can have a semi-rigid panel. The panel can be between an inner and outer layer of the wall. The panel can have a modulus of elasticity greater than about 1,000,000 and a thickness greater than about 0.0002 in. The panel can be a metal foil. The balloon can be pleated before use.

A method for making an inflatable device for use in a biological body is disclosed. The method can include forming a leak-proof member from solid film on a removable mandrel. The forming can occur at a temperature below 100° Celsius. the forming occurs without solvation of the film. The method can further include adhering the film to the mandrel, wherein adhering comprises adhering with a water-soluble tacking adhesive. The mandrel can be removed by dissolving the mandrel with water. Forming can include pressure-forming. (i.e., hydroforming with a fluid, even air).

The method can also include trimming the film. The thermoset film can have one or more fibers or no fiber. The film can be substantially anisotropically mechanically load-bearing. For example, the load-bearing properties of the film can be substantially unidirectional along the surface plane of the film.

A method for making the device is disclosed that can include adhering with a first bonding agent a first film to a mandrel, forming the first film on about the first half of the mandrel, bonding with a second bonding agent the first film to a second film, forming the second film on about the second half of the mandrel, and dissolving the mandrel. Dissolving can include applying water to the mandrel. The first bonding agent can be water-soluble. The mandrel can be made from a sugar, a plastic, polylactic acid (PLA), polyvinylacetate, a water-soluble wax, or combinations thereof.

A method for making the device is disclosed that can include positioning a solid film on a mandrel and dissolving the mandrel with the solid film on the mandrel. Dissolving can include dissolving with water. The film can be water-tight. The film can be configured as a flat piece of film before forming on the mandrel. The film can have a square or rectangular shape before forming on the mandrel.

Also disclosed is a method for making the device that can include creating a first hole that transects a mandrel, passing a fiber through the first hole, forming a layer of material on the mandrel, attaching the layer to the fiber, and dissolving the mandrel. Attaching can include attaching the fiber to the side of the layer against the mandrel, attaching the fiber to the side of the layer away from the mandrel, attaching the fiber to the inside of the layer, or combinations thereof.

A method for making the device is disclosed that can include applying fibers to a mandrel, applying an elastomeric resin to the fibers and bonding the fibers to the mandrel. Applying the fibers can include rotating the mandrel while feeding the length of the fibers from a location off the mandrel. The fibers or layer containing the fibers can be bonded to the mandrel or to an adjacent layer to prevent the fibers from slipping against the mandrel or adjacent layer. The mandrel can have an ovaloid shape.

A method for making the device is disclosed that can include applying a first layer of a material on a water-soluble mandrel and forming a thermoset film on the first layer. The method can be performed at a temperature from about 5 degrees Celsius to about 35 degrees Celsius, more narrowly from about 15° C. to about 30° C., for example at ambient or room temperature (e.g., about 18° C. to about 25.5° C.).

A method for making the device is disclosed that can include applying a first layer of a material on a mandrel, bonding with a first bonding agent a first thermoset film to the first layer, forming the first thermoset film on about the first half of the first layer, bonding with a second bonding agent the first thermoset film to a second thermoset film, forming the second thermoset film on about the second half of the first layer, and dissolving the mandrel.

A method for making the device is disclosed that can include applying a first layer of a material on a mandrel, hydroforming an MMA-resistant film on the first layer; and dissolving the mandrel with water.

A method for using the device is disclosed that can include inserting the inflatable device adjacent to a target site, expanding the inflatable device to a pressure greater than about 350 kPa (51 psi), and delivering to the target site thermal energy generated in the wall of the inflatable device. Delivering the energy can include singeing or ablating tissue at the target site.

The balloon can be attached to a deployment tool having a deployment rod. The deployment rod can have a rod distal end. The deployment rod can be positioned at least partially inside the balloon when the balloon is in a deflated state. The deployment rod can be slidably adjustable with respect to the location of the proximal end of the balloon. The deployment rod can be in an extended position when the balloon is in the substantially deflated state. The deployment rod can be in a retracted position when the balloon is in the substantially inflated state. The rod distal end can be out of substantial contact with the balloon distal end when the balloon is in the substantially inflated state.

The rod distal end can be in contact with the balloon distal end when the balloon is in the substantially deflated state.

The deployment tool can have a fluid channel configured to deliver fluid to the balloon. When the deployment rod is in an extended position, the deployment rod can substantially obstruct the fluid channel. When the when the deployment rod is in a retracted position, the deployment rod can leave the fluid channel substantially unobstructed by the deployment rod retracting the deployment rod with respect to the balloon, wherein retracting comprises substantially unobstructing fluid delivery through the fluid channel. Further comprising delivering fluid to the balloon after retracting the deployment rod.

The deployment rod can be positioned at least partially inside the balloon when the balloon is in a deflated state. The deployment rod can be fixed with respect to the location of the proximal end of the balloon. The rod distal end can be substantially separate (i.e., not in substantial or any contact) with the balloon wall when the balloon is in the substantially inflated state. The rod distal end can be atraumatic. The rod distal end can have a curved surface facing the balloon distal end. The deployment rod can be stiffer than the balloon when the balloon is in a contracted state.

A method for using the device is disclosed that can include inserting a working channel through the biological body, delivering a first balloon through the working channel and positioning the first balloon at the target site. After the delivering the first balloon, the method can include delivering a second balloon through the working channel and positioning the second balloon at the target site while the first balloon is at the target site. The method can also include delivering an unsupported (i.e., in free air or about standard atmospheric pressure) pressure of greater than about 1400 kPa (200 psi) to the first and/or second balloon. The working channel can have an inner diameter less than about 5 mm. The working channel can have a distal port. The distal port can be positioned adjacent to, or at, the target site, such as the inside of a vertebral body. The second balloon can be inflated after or concurrent with inflating the first balloon.

The working channel can have an inner diameter less than about 5 mm. The first and second balloons can be attached to separate first and second deployment systems, respectively, enabling independent orientation and/or translation of the first balloon from the second balloon, or the first and second balloons can be attached to a single integral joint deployment system.

An inflatable device system is disclosed that can include a curved guide block, a drill, a trocar, a first balloon, a steering mechanism, and combinations thereof. A method for using the system can include positioning a guide block outside of the biological body and delivering a drill through the guide block. The method can include delivering the device through the guide block and into the biological body.

An inflatable device system is disclosed that can have a balloon, a reservoir, a fluid in the reservoir; and a sealed sterile package. The balloon, the reservoir and the fluid can be in the sealed sterile package.

An inflatable device kit is disclosed that can have a balloon having a fully inflated state having an inflated volume, a fluid channel having a fluid channel volume, a sealed reservoir, and a fluid in the reservoir. The fluid in the reservoir can have a fluid volume. The fluid volume can be within 10% of the sum of the inflated volume and the fluid channel volume.

A deployment tool for use with the inflatable device is disclosed that can have a fluid first channel having an incoming port. The fluid first channel can have a luer connector at the incoming port, a check valve and a swabbable valve. The swabbable valve can be adjacent to the luer connector. The check valve can be downstream from the luer connector.

An assembly for use in percutaneously treating a bone predisposed to fracture or to collapse, or that is fractured or collapsed, is disclosed. The assembly can have a cannula, a balloon, a catheter and a driving rod. The balloon can be insertable through the cannula into bone. The balloon can have a deflated condition which has a size for passage through the cannula for insertion into bone. The balloon can be inflated to a predetermined shape and size sufficient for compressing at least a portion of inner cancellous bone so as to form a cavity therein. The balloon can be restrained in the inflated condition to create said predetermined shape and size by having a wall that is thicker in selected portions than it is in other portions and/or by an internal restraint provided in or on the balloon wall and/or by an external restraint in or on the balloon wall. The outer diameter of the catheter can be smaller than the inner diameter of the cannula. The cannula can be adapted to not drive the deflated balloon through the cannula into the bone. The driving rod can releasably attach to the device. The driving rod can be adapted to drive the balloon through the cannula into the bone.

The catheter can have an elastomer and a fiber. The driving rod can have a shaft and a clasp at the distal end of the shaft.

A method for using the device is disclosed that includes inserting a balloon into the target site, inflating the balloon and injecting a load of bone cement into the target site. The load of bone cement can cure while in contact with the balloon. The balloon does not substantially degrade from contact with the load of bone cement. The balloon can have a fiber made from a substantially different material than the remainder of the balloon. Inserting can include inserting with a detachable driving rod. The method can include creating a void at the target site.

The balloon can be non-compliantly expanded. For example, the wall of the balloon can expand no more than about 2% to about 3% strain between the deflated state to the inflated state.

The device can be used to perform valvuloplasty, annuloplasty, kyphoplasty, sinuplasty or angioplasty procedures. The device can be used to minimally invasively deliver and expand a vascular stent, graft or heart valve. The device can be used to expand constrictions in the urethra. The device can be used to dilate CTOs. The device can be used to temporarily or permanently occlude vessels, for example to isolate a space within a vessel to locally deliver drugs or to intentionally cause necrosis. The device can be used to deliver therapeutic and/or diagnostic drugs. The device can be used to deliver energy to warm, singe or ablate adjacent tissue. The device can be used as a radiopaque or echogenic marker. The device can be used during a balloon enteroscopy procedure or during colonoscopy. The device can be used to cut, tear, or otherwise rip tissue. The device can be implanted and inflated to create an anatomical feature, such as a breast implant.

BRIEF DESCRIPTION OF THE FIGURES

<figref idref="DRAWINGS">FIG. 1</figref> illustrates a variation of the device.

<figref idref="DRAWINGS">FIG. 2</figref> illustrates a variation of cross section A-A of <figref idref="DRAWINGS">FIG. 1</figref>.

<figref idref="DRAWINGS">FIGS. 3A through 3C</figref> are cross-sectional views of a length of variations of the device.

<figref idref="DRAWINGS">FIG. 4A</figref> illustrates a variation of the device.

<figref idref="DRAWINGS">FIGS. 4B and 4C</figref> are variations of cross-section C-C of <figref idref="DRAWINGS">FIG. 4A</figref>.

<figref idref="DRAWINGS">FIG. 5A</figref> illustrates a variation of the device.

<figref idref="DRAWINGS">FIGS. 5B and 5C</figref> are variations of cross-section D-D of <figref idref="DRAWINGS">FIG. 5A</figref>.

<figref idref="DRAWINGS">FIG. 6A</figref> illustrates a variation of the device.

<figref idref="DRAWINGS">FIG. 6B</figref> is a variation of cross section E-E of the device of <figref idref="DRAWINGS">FIG. 6A</figref>.

<figref idref="DRAWINGS">FIG. 6C</figref> is a variation of cross section F-F of the device of <figref idref="DRAWINGS">FIG. 6A</figref>.

<figref idref="DRAWINGS">FIG. 6D</figref> is a variation of cross section G-G of the device of <figref idref="DRAWINGS">FIG. 6A</figref>.

<figref idref="DRAWINGS">FIGS. 7 and 8</figref> illustrate variations of the device.

<figref idref="DRAWINGS">FIG. 9A</figref> illustrates a variation of the device in a deflated state.

<figref idref="DRAWINGS">FIG. 9B</figref> illustrates a variation of the device in an inflated state.

<figref idref="DRAWINGS">FIGS. 10A through 10D</figref> illustrate variations of the device.

<figref idref="DRAWINGS">FIGS. 11A and 11B</figref> illustrate partially see-through variations of the device.

<figref idref="DRAWINGS">FIGS. 11C through 11F</figref> are variations of cross-section H-H of <figref idref="DRAWINGS">FIG. 11A</figref>.

<figref idref="DRAWINGS">FIGS. 12 through 18</figref> illustrate variations of the device.

<figref idref="DRAWINGS">FIG. 19A</figref> illustrates a variation of the device.

<figref idref="DRAWINGS">FIG. 19B</figref> is a variation of cross section i-i of <figref idref="DRAWINGS">FIG. 19A</figref>.

<figref idref="DRAWINGS">FIG. 20A</figref> illustrates a variation of the device.

<figref idref="DRAWINGS">FIG. 20B</figref> is a variation of cross section JJ of <figref idref="DRAWINGS">FIG. 19A</figref>.

<figref idref="DRAWINGS">FIGS. 21A and 21B</figref> are top and bottom perspective views, respectively, of a variation of the device.

<figref idref="DRAWINGS">FIG. 22A</figref> illustrates a variation of the device.

<figref idref="DRAWINGS">FIG. 22B</figref> is a variation of cross-section K-K of <figref idref="DRAWINGS">FIG. 22A</figref>.

<figref idref="DRAWINGS">FIG. 23A</figref> illustrates a variation of the device.

<figref idref="DRAWINGS">FIGS. 23B and 23C</figref> are variations of cross-section L-L of <figref idref="DRAWINGS">FIG. 23A</figref>.

<figref idref="DRAWINGS">FIG. 24A</figref> illustrates a variation of the device.

<figref idref="DRAWINGS">FIG. 24B</figref> is a variation of cross-section M-M of <figref idref="DRAWINGS">FIG. 24A</figref>.

<figref idref="DRAWINGS">FIGS. 25 through 28</figref> are cross-sectional views of variations of the device.

<figref idref="DRAWINGS">FIG. 29A</figref> illustrates a variation of the device.

<figref idref="DRAWINGS">FIG. 29B</figref> is a variation of cross-section N-N of <figref idref="DRAWINGS">FIG. 29A</figref>.

<figref idref="DRAWINGS">FIGS. 30A, 31A, 32A, 33A and 34A</figref> illustrate variations of the device.

<figref idref="DRAWINGS">FIGS. 30B</figref>; <b>30</b>C; <b>31</b>B; <b>32</b>B; <b>33</b>B; <b>34</b>B and <b>34</b>C are variations of cross-sectional views P-P through T-T respectively, of <figref idref="DRAWINGS">FIGS. 30A, 31A, 32A, 33A and 34A</figref>, respectively.

<figref idref="DRAWINGS">FIG. 35A</figref> illustrates a variation of the device.

<figref idref="DRAWINGS">FIG. 35B</figref> is a variation of cross-section U-U of <figref idref="DRAWINGS">FIG. 35A</figref>.

<figref idref="DRAWINGS">FIG. 36A</figref> illustrates a variation of the device.

<figref idref="DRAWINGS">FIG. 36B</figref> is a variation of cross-section V-V of <figref idref="DRAWINGS">FIG. 36A</figref>.

<figref idref="DRAWINGS">FIG. 37A</figref> illustrates a variation of the device.

<figref idref="DRAWINGS">FIG. 37B</figref> is a variation of cross-section W-W of <figref idref="DRAWINGS">FIG. 37A</figref>.

<figref idref="DRAWINGS">FIG. 38A</figref> illustrates a variation of the device.

<figref idref="DRAWINGS">FIGS. 38B, 38C and 38D</figref> are variations of cross-section X-X and Y-Y of <figref idref="DRAWINGS">FIG. 38A</figref>.

<figref idref="DRAWINGS">FIG. 39A</figref> illustrates a variation of the device.

<figref idref="DRAWINGS">FIGS. 39B, 39C</figref> are variations of cross-section Z-Z and AA-AA respectively of <figref idref="DRAWINGS">FIG. 39A</figref>.

<figref idref="DRAWINGS">FIG. 40</figref> illustrates a variation of the device.

<figref idref="DRAWINGS">FIGS. 41A and 41B</figref> illustrate a variation of the device in deflated and inflated configurations, respectively.

<figref idref="DRAWINGS">FIGS. 42A-42E</figref> are partial see-through views of variations of the device.

<figref idref="DRAWINGS">FIG. 43</figref> illustrates a variation of an elongated element or strip.

<figref idref="DRAWINGS">FIG. 44</figref> illustrates a variation of an element of the device.

<figref idref="DRAWINGS">FIG. 45</figref> illustrates a variation of the device.

<figref idref="DRAWINGS">FIGS. 46A through 46O</figref> are sectional views through variations of cross section BB-BB of <figref idref="DRAWINGS">FIG. 1</figref>.

<figref idref="DRAWINGS">FIGS. 47 through 49</figref> are tables listing film materials, reinforcement materials, and adhesive and matrix materials, respectively.

<figref idref="DRAWINGS">FIG. 50</figref> illustrates a variation of a tool for manufacturing a variation of the inflatable device.

<figref idref="DRAWINGS">FIG. 51</figref> is a variation of cross-sectional view CC-CC of <figref idref="DRAWINGS">FIG. 50</figref>.

<figref idref="DRAWINGS">FIG. 52</figref> is a chart of material characteristics for variations of mandrel materials.

<figref idref="DRAWINGS">FIGS. 53 through 58</figref> illustrate a variation of a method for manufacturing the device.

<figref idref="DRAWINGS">FIGS. 59A through 59H</figref> illustrate a method of making fiber tape.

<figref idref="DRAWINGS">FIGS. 60 through 67</figref> illustrate a variation of a method for manufacturing the device.

<figref idref="DRAWINGS">FIG. 68</figref> illustrates a variation of a method for removing the mandrel.

<figref idref="DRAWINGS">FIG. 69</figref> illustrates a variation of the device in an inflated state before being pleated.

<figref idref="DRAWINGS">FIG. 70</figref> illustrates a method of adding pleats or folds to a variation of the device.

<figref idref="DRAWINGS">FIG. 71</figref> illustrates a variation of the device in a deflated, pleated state.

<figref idref="DRAWINGS">FIG. 72</figref> illustrates a portion of a method that may be used to produce unidirectional fiber tape.

<figref idref="DRAWINGS">FIG. 73</figref> illustrates a portion of a method that may be used to produce unidirectional fiber tape.

<figref idref="DRAWINGS">FIGS. 74 through 77</figref> illustrate variations of arrangements of unidirectional fiber tape.

<figref idref="DRAWINGS">FIG. 78</figref> illustrates a variation of a method for making a laminate.

<figref idref="DRAWINGS">FIG. 79</figref> is a process flow chart of a variation of a process for making a laminate.

<figref idref="DRAWINGS">FIG. 80</figref> is a graph illustrating a variation of temperature and pressure verse time graph for a method for compacting or curing or melting that can be used with a fiber tape.

<figref idref="DRAWINGS">FIG. 81A-81D</figref> illustrates a variation of the mandrel.

<figref idref="DRAWINGS">FIG. 82A</figref> illustrates a variation of a manufacturing tool.

<figref idref="DRAWINGS">FIG. 82B</figref> is a variation of cross-sectional view GG-GG of <figref idref="DRAWINGS">FIG. 82A</figref>.

<figref idref="DRAWINGS">FIG. 83</figref> illustrates a variation of the fiber during a variation of a method for manufacturing the device.

<figref idref="DRAWINGS">FIG. 84</figref> is a variation of cross-sectional view GG-GG of <figref idref="DRAWINGS">FIG. 82A</figref>.

<figref idref="DRAWINGS">FIG. 85</figref> illustrates a variation of the fiber during a variation of a method for manufacturing the device.

<figref idref="DRAWINGS">FIG. 86</figref> illustrates a variation of a method for manufacturing the device.

<figref idref="DRAWINGS">FIG. 87</figref> illustrates a variation of the fiber during a variation of a method for manufacturing the device.

<figref idref="DRAWINGS">FIG. 88</figref> illustrates a variation of a method for manufacturing the device.

<figref idref="DRAWINGS">FIGS. 89 through 91D</figref> illustrate variations of a method for manufacture of the device.

<figref idref="DRAWINGS">FIGS. 92 through 94</figref> illustrate variations of methods for manufacturing the device.

<figref idref="DRAWINGS">FIGS. 95 through 100</figref> illustrate variations of laminate sheets.

<figref idref="DRAWINGS">FIGS. 101 through 107</figref> illustrate a method for manufacturing the device.

<figref idref="DRAWINGS">FIG. 108A</figref> illustrates a variation of a tool for manufacturing a variation of the inflatable device.

<figref idref="DRAWINGS">FIG. 108B</figref> is a variation of cross-sectional view II of <figref idref="DRAWINGS">FIG. 108A</figref>

<figref idref="DRAWINGS">FIGS. 109 through 115</figref> illustrate a variation of a method for manufacturing the device.

<figref idref="DRAWINGS">FIGS. 116 through 119</figref> illustrate a method for manufacturing the device.

<figref idref="DRAWINGS">FIG. 120</figref> illustrates a variation of a layer.

<figref idref="DRAWINGS">FIGS. 121 and 122</figref> illustrate variations of elongated elements.

<figref idref="DRAWINGS">FIGS. 123 and 124</figref> illustrate variations of three overlayed elongated elements.

<figref idref="DRAWINGS">FIGS. 125</figref> though <b>127</b> illustrate variations of methods for manufacturing the device.

<figref idref="DRAWINGS">FIG. 128A</figref> illustrates a variation of a manufacturing tool.

<figref idref="DRAWINGS">FIG. 128B</figref> is a variation of cross-sectional view LL-LL of <figref idref="DRAWINGS">FIG. 128A</figref>.

<figref idref="DRAWINGS">FIG. 128C</figref> is a close-up view MM-MM of <figref idref="DRAWINGS">FIG. 128B</figref>.

<figref idref="DRAWINGS">FIG. 129</figref> is a partial see-through view of a sagittal view of a spine in a patient.

<figref idref="DRAWINGS">FIG. 130</figref> is a partial see-through coronal view of a vertebra.

<figref idref="DRAWINGS">FIGS. 131,134, 135, 137, 138, 139 and 140</figref> are coronal cross-sectional views of a variation of a method of using a variation of the device in a vertebra.

<figref idref="DRAWINGS">FIG. 132</figref> illustrates a cross-section of a variation of the balloon wall.

<figref idref="DRAWINGS">FIG. 133</figref> illustrates a cross-section of a variation of the balloon contracted inside of the delivery tube.

<figref idref="DRAWINGS">FIG. 136</figref> is a graph of compliance of the variation of the balloon compared with a typical compliant balloon.

<figref idref="DRAWINGS">FIGS. 141A through 141</figref><i>i </i>are coronal cross-sectional views of a variation of a method of using a variation of the device in a vertebra.

<figref idref="DRAWINGS">FIGS. 142A through 142F</figref> are coronal cross-sectional views of a variation of a method of using a variation of the device in a vertebra.

<figref idref="DRAWINGS">FIGS. 143A through 143</figref><i>i </i>are coronal cross-sectional views of a variation of a method of using a variation of the device in a vertebra.

<figref idref="DRAWINGS">FIG. 144</figref> illustrates a variation of the delivery guide block.

<figref idref="DRAWINGS">FIGS. 145 and 146</figref> illustrate a variation of a method for using the delivery guide block.

<figref idref="DRAWINGS">FIGS. 147 through 149</figref> illustrate variations of a deployment tool with the device.

<figref idref="DRAWINGS">FIG. 150A through 150C</figref> illustrate a variation of a method for using the device and the deployment tool.

<figref idref="DRAWINGS">FIG. 151A</figref> illustrates a variation of the deployment tool.

<figref idref="DRAWINGS">FIG. 151B</figref> illustrates the proximal end of the variation of the deployment tool during use.

<figref idref="DRAWINGS">FIG. 151C</figref> is a variation of cross-sectional view PP-PP of <figref idref="DRAWINGS">FIG. 151A</figref> shown in a closed configuration.

<figref idref="DRAWINGS">FIG. 151D</figref> is a variation of cross-sectional view PP-PP of <figref idref="DRAWINGS">FIG. 151A</figref> shown in an opened configuration.

<figref idref="DRAWINGS">FIG. 152A</figref> illustrates a variation of the deployment tool.

<figref idref="DRAWINGS">FIG. 152B</figref> illustrates the proximal end of the variation of the deployment tool during use.

<figref idref="DRAWINGS">FIG. 152C</figref> is a variation of cross-sectional view QQ-QQ of <figref idref="DRAWINGS">FIG. 152A</figref> shown in a closed configuration.

<figref idref="DRAWINGS">FIG. 152D</figref> is a variation of cross-sectional view QQ-QQ of <figref idref="DRAWINGS">FIG. 152A</figref> shown in an opened configuration.

<figref idref="DRAWINGS">FIG. 153</figref> is a variation of cross-sectional view A-A of <figref idref="DRAWINGS">FIG. 1</figref>

<figref idref="DRAWINGS">FIG. 154A</figref> illustrates a variation of the device with a component for inserting the device into the body.

<figref idref="DRAWINGS">FIG. 154B</figref> is a variation of cross-sectional view RR-RR of <figref idref="DRAWINGS">FIG. 154A</figref>.

<figref idref="DRAWINGS">FIG. 155A</figref> illustrates a variation of the device with a component for inserting the device into the body.

<figref idref="DRAWINGS">FIG. 155B</figref> is a variation of cross-sectional view SS-SS of <figref idref="DRAWINGS">FIG. 155B</figref>

<figref idref="DRAWINGS">FIG. 156</figref> illustrates a variation of a system for using the device.

<figref idref="DRAWINGS">FIG. 157</figref> illustrates a variation of the deployment rod.

<figref idref="DRAWINGS">FIGS. 158 and 159</figref> illustrate a variation of a method for using the device.

<figref idref="DRAWINGS">FIG. 160</figref> is a variation of cross-sectional view TT-TT of <figref idref="DRAWINGS">FIG. 159</figref>.

<figref idref="DRAWINGS">FIG. 161</figref> is a variation of close-up of <figref idref="DRAWINGS">FIG. 160</figref>

<figref idref="DRAWINGS">FIG. 162</figref> illustrates a variation of a method for using the device.

<figref idref="DRAWINGS">FIGS. 163A, 164A, 165A and 166A</figref> illustrate variations of the device.

<figref idref="DRAWINGS">FIGS. 163B, 164B, 165B and 166</figref><i>b </i>illustrate variations of the distal ends of deployment or driving rods configured to interface with the devices of <figref idref="DRAWINGS">FIGS. 163A, 164A, 165A and 166A</figref> respectively.

<figref idref="DRAWINGS">FIGS. 167,168 and 169</figref> illustrate sectional views of variations of methods for using a deployment or driving rod with the device.

<figref idref="DRAWINGS">FIG. 170</figref> illustrates a variation of a method for using a deployment or driving rod with the device.

<figref idref="DRAWINGS">FIG. 171A</figref> illustrates a variation of the shaft of the deployment rod.

<figref idref="DRAWINGS">FIGS. 171B through 171</figref><i>i </i>are variations of cross-section of <figref idref="DRAWINGS">FIG. 171A</figref>.

<figref idref="DRAWINGS">FIG. 172A</figref> illustrates a variation of a method for using a deployment or driving rod with the device.

<figref idref="DRAWINGS">FIG. 172B</figref> is a variation of cross-sectional view UU-UU of <figref idref="DRAWINGS">FIG. 172A</figref>.

<figref idref="DRAWINGS">FIGS. 173A and 173B</figref> are cross sections of variations of methods of deployment.

<figref idref="DRAWINGS">FIG. 174A</figref> is a variation of a tool for inflating the inflatable device.

<figref idref="DRAWINGS">FIG. 174B</figref> is a variation of a sectional view of <figref idref="DRAWINGS">FIG. 174A</figref>.

<figref idref="DRAWINGS">FIGS. 175 through 177</figref> illustrate variations of a kit including the device.

<figref idref="DRAWINGS">FIGS. 178 through 179F</figref> illustrate a variation of a method for valvuloplasty.

<figref idref="DRAWINGS">FIGS. 180A through 180C</figref> illustrate a variation of a method for angioplasty.

DETAILED DESCRIPTION

<figref idref="DRAWINGS">FIG. 1</figref> illustrates that a medical inflatable device <b>2</b> can have a balloon <b>20</b> and a hollow shaft <b>2000</b>. An inflation system (shown herein) can be attached to the hollow shaft to deliver a fluid pressure through the hollow shaft and to the balloon. The balloon <b>20</b> can be resilient (i.e., elastic) or non-compliant (i.e., inelastic). The balloon <b>20</b> can have a balloon longitudinal axis <b>26</b>. The balloon <b>20</b> can have a balloon wall <b>22</b>. The balloon wall <b>22</b> can define a cavity having a balloon volume <b>24</b>.

<figref idref="DRAWINGS">FIG. 2</figref> illustrates that the balloon <b>20</b> can have balloon length <b>28</b>. The balloon <b>20</b> can have a balloon proximal stem <b>30</b> having a balloon proximal stem length <b>32</b>. The proximal stem length <b>32</b> can be from about 5 mm (0.2 in.) to about 15 mm (0.6 in.). The balloon can have a balloon proximal taper <b>34</b> having a balloon proximal taper length <b>36</b>. The balloon proximal taper length <b>36</b> can be from about 0 mm (0 in.) to about 20 mm (0.8 in.), more narrowly from about 0 mm (0 in.) to about 15 mm (0.6 in.), yet more narrowly from about 5 mm (0.2 in.) to about 10 mm (0.4 in.) The balloon <b>20</b> can have a constant-diameter section <b>38</b> having a constant-diameter section length <b>40</b>. The constant-diameter section length <b>40</b> can be from about 0 mm (0 in.) to about 15 mm (0.6 in.), more narrowly from about 0 mm (0 in.) to about 10 mm (0.4 in.). The balloon <b>20</b> can have a balloon distal taper <b>42</b> at the terminal distal end <b>68</b> or tip of the balloon <b>20</b>. The distal taper <b>42</b> can have a distal taper length <b>44</b>. The distal taper length <b>44</b> can be from about 0 mm (0 in.) to about 14 mm (0.55 in.), more narrowly from about 2 mm to about 9 mm.

The proximal and/or distal tapers <b>34</b> and/or <b>42</b> can have concave, convex and/or s-curves. For example, the proximal and/or distal tapers <b>34</b> and/or <b>42</b> can have continuously varying angles with respect to the balloon longitudinal axis <b>26</b>.

The balloon <b>20</b> can have a wall thickness <b>46</b>. The wall thickness <b>46</b> can be less than about 25 μm (0.98 mil). The wall thickness <b>46</b> can be from about 25 μm (0.98 mil) to about 250 μm (9.8 mil), more narrowly from about 50 μm (2 mil) to about 150 μm (5.9 mil), for example about 75 μm (3.0 mil) or about 100 μm (4 mil).

The balloon can have a balloon inner diameter <b>48</b> and a balloon outer diameter <b>50</b>. The balloon outer diameter <b>50</b> can be measured perpendicular to the balloon longitudinal axis <b>26</b> at the widest point along the length of the balloon <b>20</b>. The balloon outer diameter <b>50</b> can be from about 2 mm (0.08 in.) to about 50 mm (in.) for example about 17 mm (0.67 in.), 23 mm (0.91 in.), 3 mm (0.12 in.), or 6 mm (0.24 in.).

The balloon can have a radius (i.e., half the diameter), for example about 8.5 mm, and a distal taper length, for example about 8.5 mm. The ratio of the distal end length to the radius can be from about 2:1 to about 0:1, more preferably about 1:1 to about 0.25:1.

The balloon can have an unsupported burst pressure. The unsupported burst pressure is the pressure at which the balloon ruptures when inflated in free air without any external constraint on the walls at about 1 atm external pressure and about 20° C. temperature. The unsupported burst pressure can be greater than about 150 psi. For example, the unsupported burst pressure can be from about 1,400 kPa (200 psi) to about 10,000 MPa (1,500 psi). More narrowly, the burst pressure can be from about 3,500 kPa (500 psi) to about 6,000 kPa (900 psi). For example, the burst pressure can be about 3,500 kPa (500 psi), about 5,200 kPa (750 psi), about 7,000 (1,000 psi), about 10,000 kPa (1,500 psi), or higher than 10,000 kPa (1500 psi).

The balloon <b>20</b> can be non-compliant or inelastic. The balloon can have a failure strain of less than 0.30, more narrowly less than 0.20, more narrowly less than 0.10, yet more narrowly less than 0.05. A non-compliant balloon can have a failure strain of less than 0.30.

The failure strain of the balloon is the difference between the balloon outer diameter when the balloon is inflated to 100% of the burst pressure and the balloon outer diameter when the balloon is inflated to 5% of the burst pressure (i.e., to expand from a deflated state without stretching the wall material) divided by the 100% pressure diameter.

For example, the burst pressure of the balloon can be greater than about 3,500 kPa (500 psi) and have an outer diameter of about 17 mm and a wall thickness of less than about 100 μm with a failure strain of less than about 0.10, for example less than about 0.05.

The reinforced balloon wall may have a high tear strength as compared to traditional polymers. Tear strength can correlate to puncture strength and toughness. For example, in a Mod Mil-C-21.189 10.2.4 tear test, a specimen is created. That specimen has a width, a height, and thickness. A slit is made in the sample parallel to the width, mid-way along its height. The slit is then pulled to initiate tear at the corners of the slit. The Mod Mil-C-21189 10.2.4 tear test gives resultant data in tensile pounds force (lbf). For the test to be meaningful as a comparison between two material samples, it should be done on a thickness-comparable basis. A nylon 12 balloon material at about 0.0055 in. thickness failed the test at a mean tensile load of 25 lbf. The balloon wall <b>22</b> of about 0.005 in. failed at a mean tensile value of 134 lbf.

In an ASTM D-3039 tensile test, a nylon 12 material at 0.0055 in. thickness, failed at a mean tensile load of 22 lbf. The balloon wall <b>22</b> of about 0.005 in. failed at a mean tensile value of 222 lbf.

The balloon wall <b>22</b> can have one or more layers <b>72</b>. The balloon <b>20</b> can have a leak-proof bladder <b>52</b>. The bladder <b>52</b> can be fluid-tight, such as an air-tight, or saline tight, or a fluid porous bladder. The bladder <b>52</b> can be made of a urethane, a nylon, any material listed infra, or combinations thereof. The bladder <b>52</b> can be made from the radial inner-most layer <b>72</b><i>b </i>of the balloon wall <b>22</b>.

The bladder <b>52</b> can be fixedly or removably attached to the hollow shaft <b>2000</b>, for example at the inside and/or outside diameter of hollow shaft <b>2000</b>. The hollow shaft <b>2000</b> can be a flexible or rigid catheter. The hollow shaft <b>2000</b> can deliver pressurized fluid to the balloon volume <b>24</b>.

The balloon <b>20</b> can have one or more balloon fluid ports <b>56</b>. The hollow shaft <b>2000</b> can have a hollow shaft distal port <b>54</b>. One of the balloon fluid ports <b>56</b> can attach to the hollow shaft distal port <b>54</b>. The balloon <b>20</b> (as shown in <figref idref="DRAWINGS">FIGS. 29A and 29B</figref>) can have a balloon fluid first port <b>56</b><i>a </i>at a proximal end of the balloon <b>20</b> and a balloon fluid second port <b>56</b><i>b </i>at a distal end of the balloon <b>20</b>. The fluid first port <b>56</b><i>a </i>can be in fluid communication with the balloon fluid second port <b>56</b><i>b </i>via a through lumen and/or the balloon volume <b>24</b>. The balloon <b>20</b> can have a single balloon fluid port <b>56</b>, two, three or more balloon fluid ports <b>56</b>. The balloon <b>20</b> can have no through lumen. For example, the balloon <b>20</b> can have no longitudinal through-lumen extending through the proximal terminal end <b>70</b> and through the distal terminal end <b>68</b>.

<figref idref="DRAWINGS">FIGS. 3A, 3B and 3C</figref> show cross sections of a balloon wall <b>22</b>. <figref idref="DRAWINGS">FIG. 3A</figref> illustrates that a balloon <b>20</b> can have a constant or varying wall thicknesses <b>46</b> along the length of the balloon <b>20</b>. A wall proximal stem thickness <b>46</b><i>a </i>can be substantially equal to a wall constant diameter section thickness <b>46</b><i>c </i>and the wall proximal taper thickness <b>46</b><i>b. </i>

<figref idref="DRAWINGS">FIG. 3B</figref> illustrates that the wall constant diameter section thickness <b>46</b><i>c </i>can be substantially greater than the wall proximal stem thickness <b>46</b><i>a</i>. The wall proximal taper thickness <b>46</b><i>b </i>can be less than the wall constant diameter section thickness <b>46</b><i>c </i>and greater than the wall proximal stem thickness <b>46</b><i>a. </i>

<figref idref="DRAWINGS">FIG. 3C</figref> illustrates that the wall proximal stem thickness <b>46</b><i>a </i>can substantially greater than the wall constant diameter section thickness <b>46</b><i>c</i>. The wall proximal taper thickness <b>46</b><i>b </i>can be less than the wall proximal stem thickness <b>46</b><i>a </i>and greater than the wall constant diameter section thickness <b>46</b><i>c. </i>

<figref idref="DRAWINGS">FIG. 4A</figref> illustrates that the balloon <b>20</b> can have a single balloon external seam <b>66</b><i>a</i>. The seam can extend partially, completely, or not at all through the depth of the wall thickness <b>46</b>. The balloon external seam <b>66</b><i>a </i>can be a longitudinal seam. The balloon external seam <b>66</b><i>a </i>can extend from a first lateral side of the balloon <b>20</b> at the proximal terminal end <b>70</b> of the balloon <b>20</b>, along the first lateral side of the balloon to the balloon distal terminal end <b>68</b>. The balloon external seam <b>66</b><i>a </i>can wrap around the balloon distal terminal end <b>68</b><i>a</i>, extending around the distal end of the balloon <b>20</b> and returning on the second lateral side of the balloon <b>20</b>.

The outer layer <b>72</b><i>a </i>of the balloon wall <b>22</b> can have an outer layer first panel <b>76</b><i>a </i>and an outer layer second panel <b>76</b><i>b</i>. The outer layer first panel <b>76</b><i>a </i>can cover from about 90° to about 270° of the balloon, as measured along the balloon longitudinal axis <b>26</b>, for example about 185° of the balloon <b>20</b>. The outer layer second panel <b>76</b><i>b </i>can cover from about 90° to about 270°, as measured along the balloon longitudinal axis <b>26</b>, for example about 185°.

<figref idref="DRAWINGS">FIG. 4B</figref> illustrates that the balloon external seam <b>66</b><i>a </i>can be an overlayed seam or lap joint. The balloon external seam <b>66</b><i>a </i>can be flush against the side (i.e., having a substantially constant radius with respect to the balloon longitudinal axis <b>26</b>) of the outer layer first panel <b>76</b><i>a </i>or outer layer second panel <b>76</b><i>b</i>. The outer layer first panel <b>76</b><i>a </i>can be radially outside of the outer layer second panel <b>76</b><i>b </i>where the outer layer first panel <b>76</b><i>a </i>overlaps the layer second panel <b>76</b><i>b</i>. The outer panels <b>76</b> may have an overlap length. The overlap length can be from about 0 mm (0 in.) to about 3 mm (0.1 in.), more narrowly from about 1 mm (0.04 in.) to about 2 mm (0.08 in.). The outer layer first panel <b>76</b><i>a </i>can be bonded or adhered (e.g., with epoxy or other adhesive) to the outer layer second panel <b>76</b><i>b</i>. The adhesive can be an epoxy.

The inner layer <b>72</b><i>b </i>can have a balloon inner seam <b>66</b><i>b</i>. The balloon inner seam <b>66</b><i>b </i>can join an inner layer first panel <b>74</b><i>a </i>and an inner layer second panel <b>74</b><i>b</i>. The inner seam <b>66</b><i>b </i>can have a similar structure to those described here for the balloon outer seam <b>66</b><i>a, </i>

<figref idref="DRAWINGS">FIG. 4C</figref> illustrates that the outer layer first panel <b>76</b><i>a </i>can be fused, solvated to, glued, adhered to, welded to, or a combination thereof, with the outer layer second panel <b>76</b><i>b </i>at the outer seam <b>66</b><i>a. </i>

<figref idref="DRAWINGS">FIG. 5A</figref> illustrates that the balloon external seam <b>66</b><i>a </i>can be a flange joint. The layer first panel can have a seam first flange <b>80</b><i>a </i>around the perimeter of the outer layer first panel <b>76</b><i>a</i>. The outer layer second panel <b>76</b><i>b </i>can have a seam second flange <b>80</b><i>b </i>around the perimeter of the layer second panel. The seam first flange can attach to the seam second flange at the balloon external seam. The flange seam can extend radially away from the balloon longitudinal axis. The balloon external seam can be reinforced. The balloon external seam can be used to cut tissue during use in a biological target site.

<figref idref="DRAWINGS">FIG. 5B</figref> illustrates that the seam first flange can be bonded or adhered to the seam second flange in the flange joint. <figref idref="DRAWINGS">FIG. 5C</figref> illustrates that the layer first panel can be fused, solvated to, glued, adhered to, welded to, or a combination thereof, with the layer second panel in the flange joint.

<figref idref="DRAWINGS">FIG. 6A</figref> illustrates that the balloon external seam <b>66</b><i>a </i>can be a lateral or latitudinal seam. The balloon external seam can be in a plane perpendicular or substantially to the balloon longitudinal axis. The balloon can have one or more balloon external seams.

The outer layer first panel <b>76</b><i>a </i>can be at the distal end of the balloon <b>20</b>. The outer layer second panel <b>76</b><i>b </i>can be at the proximal end of the balloon <b>20</b>. The layer second panel can overlay the layer first panel at the balloon external seam.

<figref idref="DRAWINGS">FIG. 6B</figref> illustrates that the outer layer first panel can overlay the outer layer second panel at the balloon external seam <b>66</b><i>a. </i>

<figref idref="DRAWINGS">FIG. 6C</figref> illustrates that the balloon wall at a first length along the balloon can have a first layer and a second layer. The first layer can be a radially inner layer <b>72</b><i>b</i>, as measured from the balloon longitudinal axis. The second layer can be a radially outer layer <b>72</b><i>a</i>. Any of the layers <b>72</b> can be a laminate of fiber and resin. The resin can be an adhesive. The fiber and resin laminate can be a matrix of the fiber in the resin.

<figref idref="DRAWINGS">FIG. 6D</figref> illustrates that the balloon wall at a second length along the balloon can have first, second and third layers. The second layer can be a first middle layer <b>72</b><i>c </i>between the inner and outer layers. Any combination of the layers can be leak-proof, reinforced with one or more fibers, resistant and releasable from MMA, or combinations thereof. For example, the first layer can be leak-proof and form the bladder. The second layer can be reinforced with a fiber. The third layer can be MMA-resistant and/or MMA-releasing.

An MMA-resistant material can substantially maintain material strength and thickness when exposed to MMA bone cement in any stage of the MMA bone cement from mixing to curing. An MMA-releasable material can form no substantial bond with MMA.

<figref idref="DRAWINGS">FIG. 7</figref> illustrates that the balloon external seam can be along the balloon at the proximal taper. The balloon external seams can be in the constant diameter section, the distal taper, the proximal taper, the proximal stem, or combinations thereof.

<figref idref="DRAWINGS">FIG. 8</figref> illustrates that balloon external seam <b>66</b><i>b </i>can lie in a plane at a non-perpendicular angle to the balloon longitudinal axis <b>26</b>. The plane in which the balloon external seam lies can form a seam angle <b>82</b> with the balloon longitudinal axis. The seam angle <b>82</b> can be from about 0° (i.e., a longitudinal seam) to about 90° (i.e., a latitudinal seam). More narrowly, the seam angle <b>82</b> can be from about 30° to about 60°. For example, the seam angle <b>82</b> can be about 0°, about 30°, about 45°, about 60°, or about 90°.

<figref idref="DRAWINGS">FIG. 9A</figref> illustrates that the balloon <b>10</b> can be pleated to form flutes <b>84</b>, for example four, five or six flutes <b>84</b>, such as first flute <b>84</b><i>a</i>, second flute <b>84</b><i>b</i>. The flutes <b>84</b> can be made from accordion pleats, box pleats, cartridge pleats, fluted pleats, honeycomb pleats, knife pleats, rolled pleats, or combinations thereof. The pleating can be heat and/or pressure formed and/or the reinforcement fibers and/or panels can be oriented to form the flutes <b>84</b>. The balloon <b>20</b> can be in a deflated configuration when the flutes <b>84</b> are shown.

<figref idref="DRAWINGS">FIG. 9B</figref> illustrates that the balloon <b>20</b> in an inflated configuration can push the pleated flutes out to form a substantially smooth outer surface. The balloon <b>20</b> can have reinforcement fibers <b>86</b>. First or longitudinal reinforcement fibers <b>86</b><i>a </i>can be parallel with the balloon longitudinal axis <b>26</b>. Second or latitudinal reinforcement fibers <b>86</b><i>b </i>can be perpendicular to the balloon longitudinal axis <b>26</b>.

The proximal end of the balloon can be bonded, glued, welded to, adhered, clamped, fused, or combinations thereof to the distal end of the hollow shaft. For example, a balloon cuff can apply a tension force between the proximal terminal end of the balloon and the distal end of the hollow shaft <figref idref="DRAWINGS">FIG. 10A</figref> illustrates that the balloon can have a blunt distal terminal end. The distal terminal end can be rounded. The distal taper can have a taper angle <b>90</b><i>a </i>measured from a perpendicular off the balloon longitudinal axis. The taper angle can be from about 0° to about 80°, more narrowly from about 2° to about 45°, yet more narrowly from about 5° to about 30°, for example about 0°, 10° or 15°.

<figref idref="DRAWINGS">FIG. 10B</figref> illustrates that the distal terminal end can be substantially flat. The taper angle of the balloon in <figref idref="DRAWINGS">FIG. 8B</figref> is lower than the taper angle of the balloon in <figref idref="DRAWINGS">FIG. 8A</figref>.

<figref idref="DRAWINGS">FIG. 10C</figref> illustrates that the distal terminal end can have facets. The facets can be angularly arranged around the balloon longitudinal axis.

<figref idref="DRAWINGS">FIG. 10D</figref> illustrates that the balloon distal terminal end can be configured to evert into the volume of the balloon. For example, the balloon distal terminal end can be hemi-toroidal, for example with an inner diameter of about 0 mm (0 in.).

<figref idref="DRAWINGS">FIG. 11A</figref> illustrates that the balloon can have a first and/or second steering wires <b>94</b><i>a </i>and/or <b>94</b><i>b</i>. The first and second steering wires <b>94</b><i>a </i>and <b>94</b><i>b </i>can be evenly (about 180° apart) or unevenly (e.g., about 90° apart) spaced from each other with respect to the balloon longitudinal axis. The balloon can have third and/or fourth steering wires (not shown) evenly spaced along the balloon wall between the first and second steering wires.

The first steering wire <b>94</b><i>a </i>can be fixed to the balloon wall at a first wire terminal <b>96</b><i>a</i>. The second steering wire can be fixed to the balloon wall at a second wire terminal <b>96</b><i>b</i>. The wire terminals <b>96</b> can be located in the constant diameter section of the balloon, the proximal taper, the distal taper, or a combination thereof. The first wire terminal <b>96</b><i>a </i>can be located at the same or a different length along the balloon as the second wire terminal <b>96</b><i>b. </i>

The steering wires <b>96</b> can be slidably translatable with respect to the balloon <b>20</b>, for example except at the terminal ends. Forces can be delivered to the steering wires <b>96</b> to angularly rotate or deflect the balloon <b>20</b> with respect to an attached member, such as a deployment rod or the hollow shaft.

<figref idref="DRAWINGS">FIG. 11B</figref> illustrates that the balloon <b>20</b> can have a steering collar <b>98</b>. The steering collar <b>98</b> can be rigid. The steering collar <b>98</b> can be a metal or plastic member embedded within or attached to the inside or outside of the balloon wall. The steering collar <b>98</b> can be a reinforced area of the balloon wall, for example, reinforced with additional reinforcement fibers. The wire terminals can be located on the steering collar. The steering wires can be fixed to the steering collar. The first steering wire can be fixed to a first steering collar. The second steering wire can be fixed to a second steering collar.

The steering collar can be located in the constant diameter section of the balloon, the proximal taper, the distal taper, or a combination thereof, for example if the balloon has the two or more steering collars and/or the steering collar is at a non-perpendicular angle to the balloon longitudinal axis.

<figref idref="DRAWINGS">FIG. 11C</figref> illustrates that the balloon can have a steering sheath <b>100</b>. The steering wire <b>94</b> can slide within the steering sheath. The steering sheath <b>100</b> can be radially inside, radially outside, or embedded within (as shown) the balloon wall <b>22</b>. The steering sheath <b>100</b> can be made from a low friction material and/or be coated with a low friction material, such as PTFE or Teflon.

<figref idref="DRAWINGS">FIG. 11D</figref> illustrates that the steering wire <b>94</b> can be located in the balloon wall <b>22</b>, for example between the inner and outer layers <b>72</b><i>b </i>and <b>72</b><i>a </i>of the balloon wall <b>22</b>. The balloon wall <b>22</b> can have no steering sheath or the steering sheath can end at a length before the wire terminal <b>98</b>.

<figref idref="DRAWINGS">FIG. 11E</figref> illustrates that the steering wire can be on the outside of the balloon wall, opposite of the balloon volume. <figref idref="DRAWINGS">FIG. 11F</figref> illustrates that the steering wire can be on the inside of the balloon wall, within the balloon volume.

<figref idref="DRAWINGS">FIG. 12</figref> illustrates that the proximal stem, proximal taper, constant diameter section, distal taper, or combinations thereof can be curved. The balloon longitudinal axis can be straight or have a balloon radius of curvature <b>102</b>. The balloon radius of curvature <b>102</b> can be from about 2 to about 50 mm, for example about 5 mm, about 8 mm, or about 30 mm.

<figref idref="DRAWINGS">FIG. 13</figref> illustrates that the balloon can have a C-shaped configuration. For example, the balloon radius of curvature can be from about 5 mm to about 40 mm for example about 15 mm

<figref idref="DRAWINGS">FIG. 14</figref> illustrates that the balloon can bifurcate into a first balloon branch <b>106</b><i>a </i>and a second balloon branch <b>106</b><i>b</i>. The first balloon branch <b>106</b><i>a</i>, second balloon branch <b>106</b><i>b </i>and proximal stem <b>30</b> can be coplanar (as shown) or not coplanar. Third, fourth or more balloon branches can extend from the proximal stem. The balloon branches <b>106</b> can be in fluid communication with the proximal stem <b>30</b> and other balloon branches <b>106</b>. The balloon branches <b>106</b> can be inflated and deflated concurrently. The balloon branches <b>106</b> can be in fluid isolation from the other balloon branches <b>106</b>. The balloon branches <b>106</b> can be inflated and deflated subsequent to the other balloon branches <b>106</b>.

The proximal stem <b>30</b> can have a proximal stem longitudinal axis <b>110</b>. The balloon first branch <b>106</b><i>a </i>and the balloon second branch <b>106</b><i>b </i>can be evenly separated (by about 180°) or unevenly separated (e.g., by about 90°) with respect to the proximal stem axis <b>110</b>.

The balloon first branch <b>106</b><i>a </i>can have a first branch longitudinal axis <b>108</b><i>a</i>. The first branch longitudinal axis <b>108</b><i>a </i>can be straight or curved. The balloon second branch <b>106</b><i>b </i>can have a second branch longitudinal axis <b>108</b><i>b</i>. The second branch longitudinal axis <b>108</b><i>b </i>can be straight or curved. The balloon first branch <b>106</b><i>a </i>can have the same, the symmetric, or a different shape as the balloon second branch <b>106</b><i>b</i>. The balloon branches <b>106</b> can have symmetric c-shapes (as shown).

The balloon first branch <b>106</b><i>a </i>can have a balloon first distal terminal end <b>68</b><i>a</i>. The balloon second branch <b>106</b><i>b </i>can have a balloon second distal terminal end <b>68</b><i>b</i>. The balloon <b>20</b> can have a terminal end gap <b>104</b> between the first distal terminal end <b>68</b><i>a </i>and the second distal terminal end <b>68</b><i>b. </i>

The balloon wall can have a pressure input port in fluid communication with a pressure channel embedded in or attached to the outside or inside of the wall of the balloon. The port can be for inflating the balloon. The pressure can be delivered to the inner lumen <b>154</b><i>a</i>. The pressure can be and is conveyed with water.

The balloon wall can have a bone cement input port <b>114</b><i>a</i>. The bone cement input port <b>114</b><i>a </i>can be in fluid communication with a bone cement channel embedded in or attached to the outside or inside of the balloon wall <b>22</b>, or as an outer lumen <b>1546</b> (shown supra) within the balloon <b>20</b>.

The balloon first and/or second branch can have one or more bone cement output ports <b>114</b><i>b</i>. The bone cement channel can be in fluid communication with the bone cement output ports <b>1146</b>. The bone cement output ports can open to a contained area <b>112</b> defined by the first balloon branch and the second balloon branch. The bone cement output ports can open away from the contained area <b>112</b>. The bone cement can be a bone cement or one or more liquid, gel or solid bone fillers with no cement properties.

<figref idref="DRAWINGS">FIG. 15</figref> illustrates that the balloon can have a substantially toroidal configuration. For example, the balloon can have no balloon terminal distal end. The proximal stem can attach to a toroidal constant diameter section. The toroid can define a circular contained area <b>112</b>.

<figref idref="DRAWINGS">FIG. 16</figref> illustrates that the balloon can have a substantially cylindrical configuration. The balloon can have a balloon top <b>116</b>, balloon bottom <b>118</b> and a balloon pressure input port <b>56</b>. During inflation, the balloon <b>20</b> can expand in the vertical direction. The balloon <b>20</b> can be folded in a contracted or deflated configuration. The ratio of balloon height <b>120</b> to balloon width <b>120</b> can be 1:3. For example, the balloon can form a disc. The ratio of balloon height <b>120</b> to balloon width <b>120</b> can be 1:1, for example the balloon can expand significantly in height during expansion. The balloon top <b>116</b> can be parallel to the balloon bottom <b>118</b>. The balloon top <b>116</b> can be flat or tilted at about 10°, about 20°, or about 30° relative to the balloon bottom <b>118</b>.

<figref idref="DRAWINGS">FIG. 17</figref> illustrates that the balloon <b>20</b> can have balloon first, second, third and fourth segments <b>124</b><i>a</i>, <b>124</b><i>b</i>, <b>124</b><i>c</i>, and <b>124</b><i>d</i>. The balloon segments <b>124</b> can have cylindrical configurations. The balloon segments <b>124</b> can have segment sides <b>129</b>, segment tops <b>126</b> and segment bottoms <b>128</b>. The balloon segments <b>124</b> can be attached to the adjacent segments at the segment sides <b>129</b>. The balloon segments <b>124</b> can be in fluid communication with each other and the proximal stem, for example by a common inflation lumen, or separately in fluid communication with proximal stem. The segments can be inflated concurrently, in combinations (e.g., the first and fourth segments concurrently, then the third and second segments), or sequentially.

The proximal stem shown herein can be substituted in variations for the hollow shaft and the hollow shaft can be substituted in variations for the proximal stem.

<figref idref="DRAWINGS">FIG. 18</figref> illustrates that the balloon can have anisotropic compliance or elasticity characteristics across the balloon wall <b>22</b>. For example, the balloon <b>20</b> can be less compliant or substantially non-compliant parallel to the balloon longitudinal axis, and more compliant perpendicular to the longitudinal axis.

The balloon wall <b>22</b> can have a first unidirectional fiber-reinforced laminate <b>130</b><i>a </i>oriented at a fiber angle <b>132</b> of about 15° relative to balloon the balloon longitudinal axis. The balloon wall <b>22</b> can have a second unidirectional fiber-reinforced laminate <b>130</b><i>b </i>oriented at a fiber angle <b>132</b> of about −15° relative to the balloon longitudinal axis. As the pressure inside the balloon increases, the diameter of the balloon adjacent to the balloon longitudinal axis can be substantially constant. As the pressure inside the balloon increases, the diameter of the balloon perpendicular to the longitudinal axis can substantially increase.

<figref idref="DRAWINGS">FIGS. 19A and 19B</figref> illustrate that the balloon can have a peanut configuration, like the balloon configuration shown in Figures H and H′.

<figref idref="DRAWINGS">FIGS. 20A and 20B</figref> illustrate that a first balloon <b>20</b><i>a </i>can be bonded to a second balloon <b>20</b><i>b</i>. The first balloon <b>20</b><i>a </i>can be bonded to the second balloon <b>20</b><i>b</i>, for example along a bonded surface <b>138</b>. The bonded surface <b>138</b> can be parallel with the balloon longitudinal axis.

<figref idref="DRAWINGS">FIGS. 21A and 21B</figref> illustrate that the balloon <b>20</b> can have a flat balloon top and/or flat balloon bottom <b>116</b> and/or <b>118</b>. The balloon <b>20</b> can apply a uniform force across the balloon top and/or bottom <b>116</b> and/or <b>118</b> to the endplates of the vertebrae.

The balloon <b>20</b> can be shaped to follow the contours of the vertebral body. The balloon <b>20</b> can have a first lateral side <b>117</b><i>a </i>and a second lateral side <b>117</b><i>b</i>. The first lateral side <b>117</b><i>a </i>can have an inner radius of curvature. The second lateral side <b>117</b><i>b </i>can have an outer radius of curvature. The inner radius of curvature can be from about 5 mm to about 30 mm for example about 15 mm. The outer radius of curvature can be from about 5 mm to about 30 mm for example about 20 mm.

The inner radius of curvature side can face the posterior of the vertebral body. The outer radius of curvature side can face the anterior of the vertebral body.

<figref idref="DRAWINGS">FIGS. 22A and 22B</figref> illustrate that the balloon can have a substantially cylindrical configuration and that the balloon top and/or balloon bottom can curve when the balloon is in an expanded or inflated configuration. The balloon top can have a balloon top radius of curvature <b>140</b>. The balloon bottom can have a balloon bottom radius of curvature <b>142</b>. The balloon top radius of curvature <b>140</b> can be substantially equal to or different from the balloon bottom radius of curvature <b>142</b>. The balloon top and/or balloon bottom can be reinforced, for example altering the respective radius of curvature. The balloon top or bottom radius of curvature <b>140</b> or <b>142</b> can be from about 250 mm to about 30 mm for example about 60 mm.

<figref idref="DRAWINGS">FIG. 23A</figref> illustrates that the balloon can have a cylindrical configuration oriented with the flat balloon top and flat balloon bottom facing parallel with the balloon longitudinal axis.

<figref idref="DRAWINGS">FIG. 23B</figref> illustrates that the balloon top and/or balloon bottom can be reinforced. For example, the balloon top and/or bottom can have vanes, hard plastic or metal (e.g., tantalum) discs, one, two or more layers of laminate compared to the wall of the balloon side, or combinations thereof.

<figref idref="DRAWINGS">FIG. 23C</figref> illustrates that one, two or more internal restraints <b>144</b> can be oriented longitudinally within the balloon. For example, the internal restraints <b>144</b> can be fixed to the balloon top and the balloon bottom.

<figref idref="DRAWINGS">FIG. 24A</figref> illustrates that the balloon can have a cube or three-dimensional rectangular configuration. The balloon can have six substantially flat balloon faces <b>146</b>. The balloon faces <b>146</b> can be oriented at a right angle to the adjacent balloon faces <b>146</b>. The balloon <b>20</b> can have a balloon edge <b>148</b> between adjacent faces.

<figref idref="DRAWINGS">FIG. 24B</figref> illustrates that the balloon <b>20</b> can have a one or more first internal restraints <b>144</b><i>a</i>. The first internal restraints <b>144</b><i>a </i>can be non-compliant fibers or wires fixed to opposing balloon faces. The first internal restraints <b>144</b><i>a </i>can be oriented vertically or latitudinally within the balloon. The balloon can have one or more second internal restraints <b>144</b><i>b</i>. The second internal restraints <b>144</b><i>b </i>can be oriented perpendicular to the first internal restraints <b>144</b><i>a</i>. The second internal restraints <b>144</b><i>b </i>can be oriented laterally or latitudinally within the balloon. The balloon can have one or more third internal restraints (not shown). The third internal restraints can be oriented perpendicular to the first and second internal restraints. The third internal restraints can be oriented longitudinally within the balloon. The restraints <b>144</b> can terminate on in the inside surface of the balloon wall <b>22</b>, within the balloon wall <b>22</b> or on the outside of the balloon wall <b>22</b> (not shown).

<figref idref="DRAWINGS">FIG. 25</figref> illustrates that a first balloon <b>20</b><i>a </i>can be inflated though the first pressure inlet port <b>56</b>. A second balloon <b>20</b><i>b </i>can surround the first balloon <b>20</b><i>a</i>. The second balloon <b>20</b><i>b </i>can be inflated though a second pressure inlet port <b>58</b>. The first balloon <b>20</b><i>a </i>and the second balloon <b>20</b><i>b </i>can have different shapes when inflated. The first balloon <b>30</b><i>a </i>and the second balloon <b>30</b><i>b </i>may be inflated independently during a medical procedure. The first balloon <b>30</b><i>a </i>can be used to create an initial lumen in the body. The second balloon <b>30</b><i>b </i>can be used to shape or expand the initial lumen in the body.

<figref idref="DRAWINGS">FIG. 26</figref> illustrates that a first balloon <b>30</b><i>a </i>can be inflated though the first pressure inlet port <b>56</b><i>a</i>. The second balloon <b>30</b><i>b </i>can surround the first balloon <b>30</b><i>a</i>. The second balloon <b>20</b><i>b </i>can be separated from the first balloon <b>20</b><i>a </i>by an inter-balloon gap <b>150</b>. The second balloon <b>20</b><i>b </i>can be in contact with the first balloon <b>20</b><i>a </i>(i.e., the inter-balloon gap <b>150</b> can be 0). The second balloon <b>30</b><i>b </i>can be inflated though the second pressure inlet port <b>58</b>. The first balloon <b>20</b><i>a </i>and the second balloon <b>20</b><i>b </i>can have different shapes when inflated. The first balloon <b>20</b><i>a </i>and the second balloon <b>20</b><i>b </i>may be inflated independently during a medical procedure. The second balloon <b>20</b><i>b </i>can have holes in the balloon wall that leak inflation material during an inflation cycle. The second balloon <b>20</b><i>b </i>can be biocompatible. The inflation material can be bone cement. The bone cement can cure and leave the second balloon <b>20</b><i>b </i>implanted in the body. The first balloon <b>20</b><i>a </i>may be deflated and withdrawn before the bone cement cures.

<figref idref="DRAWINGS">FIG. 27</figref> illustrates that the balloon <b>20</b> can extend from a lateral side of the hollow shaft <b>2000</b>.

<figref idref="DRAWINGS">FIG. 28</figref> illustrates that the balloons <b>20</b> can inflate from one lateral side of the hollow shaft <b>2000</b>. Pressure is provided into the inflation lumen from the proximal end of the hollow shaft <b>2000</b>. The balloons <b>20</b> may be of the same or different shapes. There may be two balloons <b>20</b> attached to the hollow shaft <b>2000</b>. There may be four balloons attached to the hollow shaft <b>2000</b>.

<figref idref="DRAWINGS">FIGS. 29A and 29B</figref> illustrate that the balloon <b>20</b> can have a balloon first fluid port <b>56</b><i>a </i>at a first end and a balloon fluid second <b>56</b><i>b </i>port at a second end. The balloon <b>20</b> can have a distal stem <b>152</b> and a proximal stem. The balloon can have a longitudinal through lumen. The distal taper angle can be from about 0 to about 90°, more narrowly about 40° to about 15°, yet more narrowly about 30° to about 10°, for example about 22°. The proximal taper angle <b>90</b><i>b </i>can be from about 0 to about 90°, more narrowly about 40° to about 15°, yet more narrowly about 30° to about 10°, for example about 22°. The distal blunting angle <b>92</b> can be from about 0 to about 90°, more narrowly about 50° to about 85°, yet more narrowly about 60° to about 80°, for example about 68°. The distal blunting angle <b>92</b> can be about equivalent to the distal taper angle <b>90</b><i>b. </i>

<figref idref="DRAWINGS">FIGS. 30A and 30B</figref> illustrate that the balloon <b>20</b> can have a first segment <b>124</b><i>a </i>and a second segment <b>124</b><i>b</i>. The first segment <b>124</b><i>a </i>and the second segment <b>124</b><i>b </i>can be longitudinally concurrent. The distal end of the balloon wall can be attached to the distal end of the hollow shaft <b>2000</b> so the balloon wall <b>22</b> extends from the proximal side of the attachment.

<figref idref="DRAWINGS">FIG. 30C</figref> illustrates that the distal end of the balloon can be configured to extend distally past the attachment of the balloon to the hollow shaft, for example past the distal end of the hollow shaft. The shaft defining the inner lumen can translate in the longitudinal direction with respect to the hollow shaft <b>2000</b>.

<figref idref="DRAWINGS">FIGS. 31A and 31B</figref> illustrates that the distal end of the balloon wall can be attached to the distal end of the hollow shaft so the balloon wall extends from the distal side of the attachment.

<figref idref="DRAWINGS">FIGS. 32A and 32B</figref> illustrates that the distal end of the balloon wall can be attached to the distal end of the hollow shaft so the balloon wall extends from the distal side of the attachment. The proximal terminal end of the balloon can overhang the outer hollow shaft.

<figref idref="DRAWINGS">FIGS. 33A and 33B</figref> illustrate that from the proximal end to the distal end, the balloon can have a proximal taper, a first step <b>134</b><i>a</i>, a first step taper, a second step <b>134</b><i>b</i>, a second step taper, a third step <b>134</b><i>c</i>, and a distal taper, or combinations thereof. The first step <b>134</b><i>a </i>can have a first step radius <b>136</b><i>a</i>. The second step <b>134</b><i>b </i>can have a second step radius <b>136</b><i>b</i>. The third step <b>134</b><i>c </i>can have a third step radius <b>136</b><i>c</i>. The first step radius <b>136</b><i>a </i>can be greater than or less than (as shown) the second step radius <b>136</b><i>b</i>. The second step radius <b>136</b><i>b </i>can be greater than or less than (as shown) the third step radius <b>136</b><i>c</i>. The first step radius <b>136</b><i>a </i>can be greater than or less than (as shown) the third step radius <b>136</b><i>c. </i>

During use, the increasing radii steps can be used to measure the target site and use the best size of balloon without having to remove the balloon from the patient and delivering a second balloon to the target site. For example, the balloon can sequentially dilate a stenotic vessel or valve with increasing known radii (e.g., instead of purely by feel) of dilation.

<figref idref="DRAWINGS">FIGS. 34A and 34B</figref> illustrate that the first step radius and the third step radius can be substantially equal. The second step radius can be less than the first step radius and the third step radius.

<figref idref="DRAWINGS">FIG. 34C</figref> illustrates that a radially expandable implant <b>156</b> can be removably attached to the balloon wall <b>22</b>. For example, a stent, a percutaneous aortic heart valve, a replacement heart valve annulus, or combinations thereof, can be balloon-expandable and deformed into the second step before insertion of the balloon into the target site.

<figref idref="DRAWINGS">FIG. 35A</figref> illustrates that an inflation device can have a first balloon <b>20</b><i>a </i>and a second balloon <b>20</b><i>b</i>. The second balloon <b>20</b><i>b </i>can be longitudinally distal to the first balloon <b>20</b><i>a</i>. The first balloon can be directly attached to the second balloon. The first balloon <b>20</b><i>a </i>can be attached to a proximal end of a balloon joint <b>158</b>. The second balloon <b>20</b><i>b </i>can be attached to a distal end of the balloon joint <b>158</b>.

The first balloon can be in fluid communication with the second balloon. The first balloon can be inflated and/or deflated concurrent with the second balloon. The first balloon can be in fluid isolation from the second balloon. The first balloon can be inflated and/or deflated precedent or subsequent to the second balloon's inflation or deflation.

The distal terminal end of the second balloon <b>20</b><i>b </i>can have a balloon second fluid port <b>56</b><i>b</i>. The balloon second fluid port <b>56</b><i>b </i>can be in fluid communication with the hollow shaft <b>2000</b> and/or the first and/or second balloons <b>20</b><i>a </i>and/or <b>20</b><i>b. </i>

<figref idref="DRAWINGS">FIG. 35B</figref> illustrates that the fluid port can be in fluid communication with an inner lumen. The inner lumen and balloon second fluid port can be made of a material that does not bond to or degrade by exposure to common bone cements, such as methyl methacrylate. A middle lumen <b>154</b><i>c </i>can be in fluid communication with the interior of the second balloon <b>20</b><i>b</i>. The middle lumen <b>154</b><i>c </i>can inflate the second balloon <b>20</b><i>b. </i>

The outer lumen <b>154</b><i>b </i>can be in fluid communication with the interior of the first balloon <b>20</b><i>a</i>. The outer lumen <b>154</b><i>b</i>, can inflate the first balloon <b>20</b><i>a</i>. Various pumps, syringes or pressure sources (not shown), or combinations thereof, can attach and deliver fluid pressure to the inner, middle or outer lumens <b>154</b><i>a</i>, <b>154</b><i>c</i>, <b>154</b><i>b. </i>

The device <b>2</b> can be inserted into a structure in the body. The structure can be bone. As described herein, the first and second balloons <b>20</b><i>a </i>and <b>20</b><i>b </i>can be inflated to create a balloon void in the body structure. One of the balloons <b>20</b> can be deflated and left in the body. An adhesive, (for instance, bone cement) can be injected though the inner lumen <b>154</b><i>a </i>and emerge from the balloon second fluid port <b>56</b><i>b </i>into the balloon void created in the body. The adhesive can fill or partly fill the portion of the balloon void created by the just-deflated balloon. The adhesive can cure while the other balloon remains inflated. The remaining balloon can then be deflated and the inflation system withdrawn. Adhesive can be injected to fill or partially fill the lumen created in the body structure by the inflation system. More than two balloons (e.g., three or four) can be used with the inflation system.

<figref idref="DRAWINGS">FIGS. 36A and 36B</figref> illustrate that the balloon <b>20</b> can have a toroidal or annular shape. A fluid conduit <b>176</b> can extend from the hollow shaft <b>2000</b> to the balloon <b>20</b>. The fluid conduit <b>176</b> can delivery fluid pressure to inflate and deflate the balloon <b>20</b>. The balloon <b>20</b> can have an inner wall <b>22</b><i>a </i>and an outer wall <b>22</b><i>b</i>. The inner wall <b>22</b><i>a </i>can be radially inside the outer wall <b>22</b><i>b</i>. The balloon <b>20</b> can have an annular lumen <b>160</b> passing through the radial center of the balloon <b>20</b>. The annular lumen <b>160</b> can open to an annular lumen distal port <b>162</b><i>a </i>and an annular lumen proximal port <b>162</b><i>b. </i>

The distal end of the annular lumen <b>160</b> can be attached to one or more distal tensioners <b>164</b><i>a</i>. The distal tensioners <b>164</b><i>a </i>can be elastic or inelastic wires, fibers or threads. The distal tensioners <b>164</b><i>a </i>can be fixed at distal tensioner first ends evenly or unevenly angularly distributed around the distal end of the balloon <b>20</b>. The distal tensioners <b>164</b><i>a </i>can attach at distal tensioner second ends to a distal tension anchoring wrap <b>166</b><i>a</i>. The distal tension anchoring wrap <b>166</b><i>a </i>can be fixed to the hollow shaft <b>2000</b>.

The proximal end of the annular lumen <b>160</b> can be attached to one or more proximal tensioners <b>164</b><i>b</i>. The proximal tensioners <b>164</b><i>b </i>can be elastic or inelastic wires, fibers or threads. The proximal tensioners <b>164</b><i>b </i>can be fixed at proximal tensioner first ends evenly or unevenly angularly distributed around the proximal end of the balloon. The proximal tensioners <b>164</b><i>b </i>can attach at proximal tensioner second ends to a proximal tension anchoring wrap <b>166</b><i>b</i>. The proximal tension anchoring wrap <b>166</b><i>b </i>can be fixed to a tensioning collar <b>168</b>.

The second step can form a waist. The waist can have additional hoop wrapped fibers. The waist can be substantially non-compliant. The waist can be from about 0 mm to about 12 mm in the balloon longitudinal direction, more narrowly from about 3 mm to about 9 mm. The waist diameter can be from about 2 mm to about 35 mm, for example about 3 mm, about 6 mm, about 20 mm, or about 23 mm.

The tensioning collar <b>168</b> can be slidably attached to the hollow shaft <b>2000</b>. The tensioning collar <b>168</b> can translate longitudinally, as shown by arrows in <figref idref="DRAWINGS">FIG. 36B</figref>, along the shaft. The tensioning collar can be pulled and/or pushed by a control line <b>170</b> or rod. Before deployment of the inflatable device and after deployment but before removal of the inflatable device, the balloon can be deflated and contracted against the hollow shaft. For example, the control line can be pulled to retract the proximal end of the balloon. For example, the balloon can fold and contract against the hollow shaft. The balloon may be pleated such that, when the tensioning collar is pulled or when a vacuum is applied tot the inflatable device, the balloon contracts into a small, packed form (not shown).

The balloon can have a distal segment <b>172</b><i>a </i>and a proximal segment <b>172</b><i>b</i>. The distal segment <b>172</b><i>a </i>and the proximal segment <b>172</b><i>b </i>can be annular or toroidal. The annular or toroidal planes can be perpendicular to the balloon longitudinal axis <b>26</b>. The distal segment <b>172</b><i>a </i>can be longitudinally adjacent to the proximal segment <b>172</b><i>b</i>. The distal segment <b>172</b><i>a </i>can be directly bonded to the proximal segment <b>172</b><i>b </i>or joined to the proximal segment <b>172</b><i>b </i>by a segment joint <b>174</b>. The segment joint <b>174</b> can be open and allow fluid communication between the proximal segment <b>172</b><i>b </i>and the distal segment <b>172</b><i>a </i>(not shown) or can be closed to isolate the fluid volume or the proximal segment <b>172</b><i>b </i>from the fluid volume of the distal segment <b>172</b><i>a. </i>

The distal segment and/or the proximal segment may be inflated by a tube. The tube may be attached to the hollow shaft.

The outer wall, the inner wall, or both walls, may contain a radiopaque material as described herein.

The outer wall of the distal segment can form the first step. The segment joint can form the second step. The outer wall of the proximal segment can form the third step. The second step can be radially smaller than the first step and the second step. A device, such as a minimally invasive replacement heart valve can be attached to the outside of the balloon.

<figref idref="DRAWINGS">FIGS. 37A and 37B</figref> illustrate that the device (shown in <b>36</b>A and <b>36</b>B) can have a valve <b>178</b>. The valve <b>178</b> can have a first leaflet <b>180</b><i>a</i>, a second leaflet <b>180</b><i>b</i>, a third leaflet (not shown), or more. The leaflets <b>180</b> can be thin and flexible. The leaflets <b>180</b> can collapse inside the annular lumen when the balloon is in a contracted configuration. The valve can allow flow through the annular lumen <b>160</b> in the distal direction and prevent flow through the annular lumen <b>160</b> in the proximal direction. The valve <b>178</b> can be fixed to the distal end of the distal segment of the balloon. The leaflets <b>180</b> can be oriented to allow flow distally through the annular lumen and impede or prevent flow proximally through the annular lumen. The leaflets <b>180</b> can be oriented to allow flow proximally through the annular lumen and impede or prevent flow distally through the annular lumen.

<figref idref="DRAWINGS">FIG. 38A</figref> illustrates that the balloon can have segments that can be angularly adjacent to each other. For example, the segments and the segment joints can be parallel with the longitudinal axis. The second step can have a larger radius than the first step or the third step. The proximal and distal tensioners can attach to the segments and/or segment joints.

The segments may be inflated by a tube. The tube may be attached to the hollow shaft <b>2000</b>. The distal and/or proximal tensioners can attach to the balloon at the segment joints and/or at the segments.

The segment walls can have a radiopaque foil and/or a wire, such as a radiopaque marker wire.

<figref idref="DRAWINGS">FIG. 38B</figref> illustrates that the segments can be in fluid isolation from each other at the length along the balloon shown in <figref idref="DRAWINGS">Figure M1</figref>. The segments can have a flattened circle longitudinal cross-sectional configuration. For example, the segments can be almond or eye-shaped.

<figref idref="DRAWINGS">FIG. 38C</figref> illustrates that the segments can be in fluid communication with each other at a length along the balloon shown in <figref idref="DRAWINGS">Figure M1</figref>.

<figref idref="DRAWINGS">FIG. 38D</figref> illustrates that the segments can have a circular longitudinal cross-sectional configuration. For example, the segments can be cylindrical.

<figref idref="DRAWINGS">FIGS. 39A and 39B</figref> illustrate that the balloon can have a constant outer diameter when measured along the longitudinal axis nope, it won't quite do that. For example, the balloon can have a single step. The balloon can have an inner wall <b>22</b><i>a</i>, an outer wall <b>22</b><i>b </i>and segment joints <b>174</b>. The segment joints <b>174</b> can connect the inner wall to the outer wall. The segment joints <b>174</b> can minimize the inward radial collapse of the inner wall during inflation.

<figref idref="DRAWINGS">FIG. 39C</figref> illustrates that the hollow shaft can have an inner lumen <b>154</b><i>a </i>and an outer lumen <b>154</b><i>b</i>. The fluid conduit can be in fluid communication with the outer lumen and the balloon. The outer lumen can deliver pressure through the fluid conduit and to the balloon. The inner lumen can be a through lumen. The outer lumen can extend through the distal proximal tip.

<figref idref="DRAWINGS">FIG. 40</figref> illustrates that the balloon can have a spiral or helical configuration. The spiral can have a first winding <b>182</b><i>a</i>, a second winding <b>182</b><i>b</i>, and more (e.g., five, as shown) windings. The first winding <b>182</b><i>a </i>can be joined to the second winding <b>182</b><i>b </i>at a winding joint <b>184</b>. The winding joint <b>184</b> can have an adhesive or a weld joint. The winding joint <b>184</b> can have a strip of elastic or inelastic material attached to the adjacent windings. The balloon <b>20</b> can be formed from a single continuous lumen.

<figref idref="DRAWINGS">FIG. 41A</figref> illustrates that the first flute can have a first vane <b>186</b><i>a</i>. The second flute can have a second vane <b>186</b><i>b</i>. The vanes <b>186</b> can be embedded within or attached to the inside or outside of the balloon wall <b>22</b>. All, some, one, or none of the flutes can have vanes. The vanes <b>186</b> can be reinforcements. For example, the vanes <b>186</b> can be a laminate, foil or wafer. The foil or wafer can be a plastic or metal listed herein, such as tantalum. The vane <b>186</b> can be strong enough to cut soft or hard tissue adjacent to the pleat. The vanes <b>186</b> can be rigid or flexible.

<figref idref="DRAWINGS">FIG. 41B</figref> illustrates that in an inflated or expanded configuration, the vanes <b>186</b> can lie flat along the wall.

A single radiopaque layer can encompass substantially the entire area of the balloon (as shown in <figref idref="DRAWINGS">FIG. 1</figref>, but with a radiopaque layer congruent with the balloon <b>20</b>). The radiopaque layer can be a tantalum or other metal foil selected from a radiopaque metal such as those listed herein. The radiopaque layer can be a single continuous layer, for example as a deposition or foil lining with e.g. a deposition or foil of a metal such as tantalum. <figref idref="DRAWINGS">FIG. 42A</figref> illustrates that the balloon can have vanes can be spaced evenly around the balloon longitudinal axis. The vanes can be radiopaque and/or echogenic. The vanes can be rectangular, triangular, circular, oval, or combinations thereof. The vanes can be oblong having a major axis and a minor axis. The major axis can be parallel with the balloon longitudinal axis.

<figref idref="DRAWINGS">FIG. 42B</figref> illustrates that the balloon can have first vanes spaced evenly around the balloon longitudinal axis. The balloon can have one or more second vanes at the balloon distal terminal end.

<figref idref="DRAWINGS">FIG. 42C</figref> illustrates that the balloon can have a third vane at the proximal taper. The second and/or third vanes can partially or completely circumferentially envelope the balloon around the balloon longitudinal axis.

<figref idref="DRAWINGS">FIG. 42D</figref> illustrates that the balloon can have marker spots <b>188</b> evenly or unevenly distributed around the balloon. The marker spots <b>188</b> can be radiopaque and/or echogenic. The marker spots <b>188</b> can be circular, oval, square, triangular, rectangular, pentagonal, hexagonal, or combinations thereof. The marker spots <b>188</b> can be in a layer of the balloon wall or attached to the inner or outer surface of the balloon wall.

<b>42</b>E illustrates that the balloon can have a marker wire <b>190</b> in a helical configuration about the balloon longitudinal axis. The marker wire <b>190</b> can be radiopaque and/or echogenic. The wires <b>190</b> can be electrically conductive. The wires <b>190</b> can carry electrical current, for example for RF delivery, resistive heating, or combinations thereof. The marker wire <b>190</b> can be in a layer of the balloon wall or attached to the inner or outer surface of the balloon wall <b>22</b>.

The marker wire <b>190</b> can carry a tensile load. For example, the wire can have a 0.001 in. diameter and maintain a tensile load of 0.3 N without yield or failure. The wire can be gold.

The marker wire <b>190</b> or another configuration of a panel or wire, such as shown in <figref idref="DRAWINGS">FIG. 45</figref>, can be a resistive heating or RF element. The system can have a power supply for delivering energy, such as electrical current, to the resistive heating element. The system can have a heat control unit for controlling the level of energy delivery to the resistive heating element. The heating element can be separated positive and negative electrodes on the balloon wall outer surface and contact the target site tissue directly, within the balloon wall, or on the radial inside of the inside surface of the balloon, or combinations thereof. The heating element can have a dielectric material. Radiofrequency energy can be delivered across the dielectric material of the heating element to create ohmic heating in the tissue.

The vanes <b>186</b>, the marker spots <b>188</b> and the wires <b>190</b> can be on the inside of the balloon wall <b>22</b>, the outside of the balloon wall <b>22</b>, or within the balloon wall <b>22</b>.

<figref idref="DRAWINGS">FIG. 43</figref> illustrates a panel <b>196</b> that can be configured as an elongated member or strip <b>192</b> that can be placed in a layer of the balloon wall. The strip <b>192</b> can have a strip longitudinal axis <b>194</b>. The strip <b>192</b> can have one or more reinforcement fibers, for example, parallel and/or perpendicular with the strip longitudinal axis <b>194</b>. The strip can have one or more vanes. For example, the strip can have multiple rows of vanes.

<figref idref="DRAWINGS">FIG. 44</figref> illustrates a panel can have one, two, three, four, five, six (as shown) or more panel arms <b>200</b>, such as panel first arm <b>200</b><i>a </i>and panel second arm <b>200</b><i>b</i>. The 196 panel can be a rosette. The panel <b>196</b> can have a panel center <b>198</b>. The panel arms <b>200</b> can extend from the panel center <b>198</b>. The panel arms <b>200</b> can have arm longitudinal axes. The angle between adjacent arm longitudinal axes can be arm angles <b>202</b>.

The panel or radiopaque foil pattern can have panel arms that can be folded over a balloon <b>20</b> during manufacture such that radiopaque foil panel can be embedded within the balloon wall <b>22</b>. The radiopaque foil and any other radiopaque or metal element herein can be made from gold, platinum, platinum-iridium alloy, tantalum, palladium, bismuth, barium, tungsten, or combinations thereof. Any of the layers can have particles of gold, platinum, platinum-iridium alloy, tantalum, palladium, bismuth, barium, tungsten or combinations thereof. Any of the layers can have radiopaque dyes.

The foil can be less than about 30 μm thick, for example less than about 20 μm thick, for example about 15 μm, about 12 μm, about 10 μm or about 8 μm thick. Radiopaque foils can be cut or patterned by laser cutting, wire EDM, die cutting or deposition. The foils may be mounted to a removable backing before cutting such that a pattern of foils may be easily applied during the balloon construction process.

The panels and/or vanes can cover the distal half of the balloon. The panels and/or vanes can cover the proximal half of the balloon. The panels and/or vanes can overlap in the longitudinal center of the balloon.

The panel, such as a foil, can be located in the balloon wall <b>22</b> in an area that is exposed to increased stresses during inflation. A radiopaque foil can strengthen the balloon wall <b>22</b>.

The balloon <b>20</b> can have pleats or flutes between vanes or panels. The vanes or panels can form the pleats or flutes. A panel or vane, such as a radiopaque foil, can minimize leaks from forming between fibers in the balloon during use.

<figref idref="DRAWINGS">FIG. 45</figref> illustrates that the balloon can have a resistive heating element <b>204</b> in a layer of the balloon wall or on the radial outside or radial inside of the balloon wall. The heating element <b>204</b> can have a resistive wire on a panel. The panel can be made from copper or another metal. The heating element <b>204</b>, such as the resistive wire or panel, can be connected to a heating lead <b>206</b>. The heating lead <b>206</b> can extend proximally along the hollow shaft <b>2000</b>. The heating lead <b>206</b> can be proximally connected to a controller and power source. The balloon <b>20</b> can be used to heat, cool (e.g., when the panel is a Peltier junction), emit RF power, or combinations thereof.

The heating element can be substituted for or configured in combination with a UV-emitting element, visible light-emitting element, microwave-emitting element, ultrasonic-emitting element, or combinations thereof. The heating element <b>204</b> can be replaced or configured with a strain gauge, a peltier junction or a temperature measuring device, or combinations thereof.

The balloon can be used to treat abnormal mucosa in an esophagus, for example by positioning the heating element near or in contact with the abnormal mucosa and delivering heat. The mucosal layer of the esophageal wall, for example the columnar epithelium, can be injured or ablated and made necrotic with the balloon to normalize mucosa in the esophagus.

<figref idref="DRAWINGS">FIG. 46A</figref> illustrates that the balloon wall <b>22</b> at section BB-BB or at other sections taken through a single wall of the balloon can have a layer <b>72</b> that can have a fiber tape matrix. The fiber tape matrix can have one or more reinforcement fibers <b>86</b> and one or more resins. The resin can be a flexible adhesive <b>208</b>. The flexible adhesive can remain flexible when cured or melted to form the medical inflatable device <b>2</b>.

The fiber tape (also referred to as unidirectional fiber reinforced tape, unidirectional tape, and uni-tape) may have one, two or more monofilaments <b>86</b> running substantially parallel to each other and embedded in a flexible adhesive <b>208</b>. Uni-tape may be produced with a removable backing. The removable backing can be made of paper, plastic, film, metal, elastomer, foam, fabric or combinations thereof. The substantially parallel monofilaments may be positioned within the flexible adhesive such that they are touching each other along their length. The substantially parallel monofilaments may be positioned such that there is flexible adhesive separating each fiber along its length.

<figref idref="DRAWINGS">FIG. 46A</figref> illustrates fiber array layer <b>72</b> having a layer width <b>210</b> in cross-section. The layer width <b>210</b> can include a number of fibers <b>86</b>, for instance first fiber <b>86</b><i>a </i>and second fiber <b>86</b><i>b</i>. The layer <b>72</b> can have a linear quantity fiber density measured, for example, as the number of fibers <b>86</b> per unit of layer width <b>210</b>. The linear quantity fiber density can be equal to or greater than about 500 fibers per inch, more narrowly equal to or greater than about 1000 fibers per inch, more narrowly equal to or greater than about 2000 fibers per inch, yet more narrowly equal to or greater than about 4000 fibers per inch. For example, the liner quantity fiber density can be from about 1,000 fibers per inch to about 2,000 fibers per inch.

The fibers <b>86</b> or monofilaments can be high strength and inelastic. The fibers can have a fiber or monofilament diameter <b>212</b>, for example, from about 1 μm to about 50 μm, for example less than about 25 μm, more narrowly less than about 15 μm. The unidirectional fiber-reinforced tape can have the same or different sizes and materials of fibers within the same unidirectional fiber-reinforced tape.

The fiber tape layer <b>72</b> can have a layer thickness <b>216</b> from about 1 pin to about 50 u μm, more narrowly from about 8 μm to about 25 μm, yet more narrowly from about 10 μm to about 20 μm.

<figref idref="DRAWINGS">FIG. 46B</figref> illustrates that the fiber density can be less than the fiber density shown in <figref idref="DRAWINGS">FIG. 46A</figref>. For example, the fiber density can be about 500 fibers per inch.

<figref idref="DRAWINGS">FIG. 46C</figref> illustrates that the inner layer <b>72</b><i>b </i>can have a fiber tape having reinforcement fibers <b>86</b> in an adhesive <b>208</b>. The outer layer <b>72</b><i>a </i>can have a polymer film. The laminate shown can be a part of or the entire balloon wall <b>22</b>,

<figref idref="DRAWINGS">FIG. 46D</figref> illustrates that the outer layer <b>72</b><i>a </i>can be a fiber tape. The inner layer <b>72</b><i>b </i>can be a polymer film.

<figref idref="DRAWINGS">FIG. 46E</figref> illustrates that the outer layer <b>72</b><i>a </i>and the inner layer <b>72</b><i>b </i>can be polymer films. In any variation, the polymer films can be the same or different polymers, or any combination thereof. The first middle layer <b>72</b><i>c </i>can be a fiber tape.

<figref idref="DRAWINGS">FIG. 46F</figref> illustrates that the outer layer <b>72</b><i>a</i>, inner layer <b>72</b><i>b</i>, and second middle layer <b>72</b><i>d </i>can be polymer films. The first middle layer <b>72</b><i>c </i>can be a fiber tape. Any adjacent layers, such as the third middle layer <b>72</b><i>e </i>and the outer layer <b>72</b><i>a </i>can be joined with adhesive, by melting, solvation, welding or combinations thereof.

<figref idref="DRAWINGS">FIG. 46G</figref> illustrates the outer layer <b>72</b><i>a</i>, inner layer <b>72</b><i>b</i>, first middle layer <b>72</b><i>c </i>and third middle layer <b>72</b><i>e </i>can be polymer films. The second middle layer <b>72</b><i>d </i>can be a fiber tape.

<figref idref="DRAWINGS">FIG. 46H</figref> illustrates that the outer layer <b>72</b><i>a </i>can be a first fiber tape. The inner layer <b>72</b><i>b </i>can be adjacent to the outer layer <b>72</b><i>a</i>. The inner layer <b>72</b><i>b </i>can be a second fiber tape. The first and second fiber tapes can be uni-tapes. The fiber in first fiber tape can form an angle with the fiber in the second fiber tape. Part or all of the balloon wall <b>22</b> can have multiple fiber tape layers in a wall section area <b>131</b>. The area <b>131</b> can include a number of fibers.

Part or all of the balloon wall <b>22</b> can have a volumetric quantitative density of fibers measured, for example, as the number of fibers per unit of area. The area quantity fiber density can be equal to or greater than about 100,000 fibers per square inch, more narrowly equal to or greater than about 250,000 fibers per square inch, more narrowly equal to or greater than about 1,000,000 fibers per square inch, yet more narrowly equal to or greater than about 4,000,000 fibers per square inch. The area quantity of fiber can be about 25% of the area of a wall cross section, more narrowly about 50%, more narrowly about 75%

The ratio of the volume of the fiber tape to the volume of the fibers <b>86</b> can be about equal to or greater than about 15%, more narrowly equal to or greater than about 30%, more narrowly equal to or greater than about 50%, yet more narrowly equal to or greater than about 75%.

<figref idref="DRAWINGS">FIG. 46I</figref> illustrates that a balloon wall <b>22</b> can be made by positioning, as shown by arrows, an inner layer <b>72</b><i>b </i>having a first laminate <b>130</b><i>a </i>on the outer layer <b>72</b><i>a </i>having a second laminate <b>130</b><i>b</i>. The first laminate <b>130</b><i>a </i>can be consolidated to the second laminate <b>130</b><i>b</i>. Consolidation can include heating, pressurizing, solvating, or combinations thereof of the first laminate <b>130</b><i>a </i>and the second laminate <b>130</b><i>b. </i>

<figref idref="DRAWINGS">FIG. 46J</figref> illustrates that the outer layer <b>72</b><i>a</i>, and inner layer <b>72</b><i>b </i>can be polymer films. The first middle layer <b>72</b><i>c </i>and the second middle layer <b>72</b><i>d </i>can be fiber tapes.

<figref idref="DRAWINGS">FIG. 46K</figref> illustrates that the outer layer <b>72</b><i>a</i>, inner layer <b>72</b><i>b</i>, second middle layer <b>72</b><i>d</i>, and third middle layer <b>72</b><i>e </i>can be polymer films. The first middle layer <b>72</b><i>c </i>and the fourth middle layer <b>72</b><i>f </i>can be fiber tape.

<figref idref="DRAWINGS">FIG. 46L</figref> illustrates that the balloon wall <b>22</b> can be made by positioning, as shown by arrows, a first laminate <b>130</b><i>a </i>on a second laminate <b>130</b><i>b</i>. The first laminate <b>130</b><i>a </i>can be consolidated to the second laminate <b>130</b><i>b</i>. The first laminate <b>130</b><i>a </i>can have the outer layer fixed to the fourth middle layer, which can be fixed to the third middle layer. The second laminate <b>1306</b> can have the inner layer fixed to the first middle layer, which can be fixed to the second middle layer.

<figref idref="DRAWINGS">FIG. 46M</figref> illustrates that the outer layer <b>72</b><i>a</i>, inner layer <b>72</b><i>b</i>, second middle layer <b>72</b><i>d</i>, third middle layer <b>72</b><i>e</i>, fifth middle layer <b>72</b><i>g</i>, and sixth middle layer <b>72</b><i>h </i>can be polymer films. The first middle layer <b>72</b><i>c</i>, fourth middle layer <b>72</b><i>f </i>and seventh middle layer <b>72</b><i>i </i>can be fiber tapes.

<figref idref="DRAWINGS">FIG. 46N</figref> illustrates that the balloon wall <b>22</b> can be made by joining, as shown by arrows, a first laminate <b>130</b><i>a</i>, a second laminate <b>130</b><i>b</i>, and a third laminate <b>130</b><i>c. </i>

<figref idref="DRAWINGS">FIG. 46O</figref> illustrates that the outer layer <b>72</b><i>a </i>can be an MMA-resistant and MMA-releasing polymer film. The inner layer <b>72</b><i>b </i>can be a leak proof bladder made from a polymer film. The first middle layer <b>72</b><i>c </i>can be a fiber tape, for example with the fibers oriented as longitudinal fibers. The second middle layer <b>72</b><i>d </i>can be a resin or adhesive. The third middle layer <b>72</b><i>e </i>can be a fiber tape, for example with the fibers oriented as latitudinal or hoop fibers. The fourth middle layer <b>72</b><i>f </i>can be a resin or adhesive. The fifth middle layer <b>72</b><i>g </i>can be a radiopaque layer, such as a metal foil. The sixth middle layer <b>72</b><i>h </i>can be a resin or adhesive.

Any of the polymer or fiber tape layers can be leak proof, water tight, air tight, MMA-resistant, MMA-releasing, or combinations thereof.

Magnetic resonance visualization enhancement materials, such as magnetic contrast agents, can be added to the adhesive, the film or the fiber. The magnetic resonance visualization enhancement materials can enhance the visualization of the balloon during an magnetic resonance imaging (MRI) procedure. For example, the magnetic resonance visualization enhancement material can be gadolium, Omniscan, Optimark, ProHance, Magnevist, Multihance, or combinations thereof.

Any of the layers, for example the outer layer, can be tinted or dyed a visible spectrum color. For example, a pigment, coloring additive, dispersions or other coloring agents, such as an coloring additive from Plasticolors (Ashtabula, Ohio) can be added to the adhesive, laminate or fiber before consolidation. A paint or coating can be added to a layer surface or to the outer surface of the balloon wall.

The color can be selected for branding, market differentiating, as an indication of the type of device, the size of the device, or combinations thereof. For example, devices having a selected diameter, length, pressure rating, clinical indication or efficacy, other common performance metric, or combinations thereof, can be dyed a specific color (e.g., green for a first type of device, red for a second type of device).

The layers can have one or more optical fibers. The fiber optic can be a strain sensor. The strain sensor can monitoring the laminate's mechanical status in real time. The fiber optic can guide light delivery into the body. The fiber optic can visualize a target site (e.g., gather light from the body to produce a visual image).

<figref idref="DRAWINGS">FIG. 47</figref> illustrates polymer films from which the layers can be made. The thickness of the polymer films can be from about 2 μm to about 50 μm, more narrowly from about 2 μm to about 18 μm, yet more narrowly from about 4 μm to about 12 μm.

<figref idref="DRAWINGS">FIG. 48</figref> illustrates materials from which the reinforcement fibers can be made.

<figref idref="DRAWINGS">FIG. 49</figref> illustrates that the adhesive can be an elastomeric thermoset material, an elastomeric thermoplastic material, or a combination thereof. The adhesive can be selected from any of the materials, or combinations thereof, listed in <figref idref="DRAWINGS">FIG. 49</figref>. The matrix can have a resin and a fiber. The resin can be an adhesive.

METHOD OF MANUFACTURE

<figref idref="DRAWINGS">FIGS. 50 and 51</figref> illustrate that the device can be partially or completely manufacturing in a pressure chamber <b>219</b>. The pressure chamber <b>219</b> can be in a pressure chamber case <b>218</b>. The pressure chamber case <b>218</b> can have a case top <b>220</b><i>a </i>separatable from a case bottom <b>220</b><i>b</i>. The case top <b>220</b><i>a </i>can have a case top port <b>222</b>. The case bottom <b>220</b><i>b </i>can have a case bottom port <b>224</b>. The case top port <b>222</b> can be in fluid communication with the top of the pressure chamber <b>219</b>. The case bottom port <b>224</b> can be in fluid communication with the bottom of the pressure chamber <b>219</b>.

The case top can screw or otherwise tightly join to the case bottom. The pressure chamber case can have one or more o-rings (not shown) in o-ring seats <b>226</b>.

The pressure chamber can have a mandrel seat <b>228</b>. The mandrel seat <b>228</b> can be configured to receive a mandrel <b>230</b>. The mandrel seat <b>228</b> can have holes or pores. The holes or pores in the mandrel seat <b>228</b> can allow pressure from the case bottom port and the bottom of the pressure chamber to reach the top surface of the mandrel seat around the mandrel and/or directly under the mandrel.

The mandrel <b>230</b> can have the inner dimensions of the balloon <b>20</b>.

The mandrel <b>230</b> can be a water soluble mandrel. The mandrel may be made from a low melting point wax or metal, a foam, some collapsing structure or an inflatable bladder. The mandrel can be made from a eutectic or non-eutectic bismuth alloy and removed by raising the temperature to the melt point of the metal. The mandrel can be made from aluminum, glass, sugar, salt, corn syrup, hydroxypropylcellulose, ambergum, polyvinyl alcohol (PVA, PVAL or PVOH), hydroxypropyl methyl cellulose, polyglycolic acid, a ceramic powder, wax, ballistic gelatin, polylactic acid, polycaprolactone or combinations thereof.

<figref idref="DRAWINGS">FIG. 52</figref> illustrates characteristics of bismuth alloys from which the mandrel can be made. The characteristics are characterized by melting temperature (as shown in the third row of <figref idref="DRAWINGS">FIG. 52</figref>) of the bismuth alloy.

The mandrel can be transparent or translucent to light and/or an electron beam. The mandrel can be hollow. The outside surface of the mandrel can be coated in a release agent.

The mandrel may be molded, machined, cast, injection molded or combinations thereof.

The mandrel can be in the mandrel seat and a first panel to be formed into about half of the inner layer of the balloon wall can be placed between the case top and the case bottom. The case top can then be secured to the case bottom.

<figref idref="DRAWINGS">FIG. 53</figref> illustrates that the outer surface of the mandrel can have some glue or first adhesive. The first adhesive can be located around the perimeter of the first panel's contact area with the mandrel. The first adhesive can be water soluble. The first adhesive can be a sugar syrup.

<figref idref="DRAWINGS">FIG. 54</figref> illustrates that a positive pressure can be applied to the top of the pressure chamber (e.g., through the case top port) and/or a negative pressure or suction applied to the bottom of the pressure chamber (e.g., through the case bottom port). The layer can get sucked and/or pressed down onto the mandrel. The first panel can be smoothly fitted to the mandrel and adhered to the mandrel at the first adhesive.

<figref idref="DRAWINGS">FIG. 55</figref> illustrates that the mandrel and layer can be mounted into a trimming jig <b>231</b>. Any excess portion of the first panel extending from the mandrel can be trimmed with a blade <b>235</b>, with a laser, with a water jet cutter or with a die cut tool. The trimming jig <b>231</b> can cover the mandrel and the first panel attached to the mandrel. Several layers can be formed over the mandrel and cut. The layers may be trimmed at the same time or one at time.

<figref idref="DRAWINGS">FIG. 56</figref> illustrates that the mandrel can have the excess area or the first panel removed in preparation for attachment to the second panel.

<figref idref="DRAWINGS">FIG. 57</figref> illustrates that a second adhesive can be applied to the first panel around the perimeter of the second panel's contact area with the first panel. The second adhesive can be an epoxy, urethane, a cyanoacrylate, a UV cure, or combinations thereof. The mandrel can be seated in the mandrel seat with the first panel in the mandrel seat. The second panel can be placed on the mandrel as shown (upside down relative to the <figref idref="DRAWINGS">FIGS. 50 and 51</figref> for illustrative purposes).

<figref idref="DRAWINGS">FIG. 58</figref> illustrates that after the case top is secured to the case bottom, the positive and/or negative pressures can be applied to the pressure chamber as described infra. The second panel can be smoothly fitted or pressure formed to or against the mandrel and adhered to the first panel at the second adhesive. The first and second panels can form the inner layer of the balloon wall. Multiple layers can be made by repeating the method described infra. The pressure chamber can be heated, for example, to decrease the viscosity of and decrease the modulus of the panels.

<figref idref="DRAWINGS">FIG. 59A</figref> illustrates that a layer of fiber tape can be made on a roller <b>232</b>. The roller can be configured to rotate about a roller axle <b>234</b>. The roller may have a diameter from about 1 mm to about 100 mm. The roller may be made or coated with an anti-stick material such as a fluoropolymer.

<figref idref="DRAWINGS">FIG. 59B</figref> illustrates that a releaser <b>236</b>, such as a release layer, can be placed around the circumference of the roller <b>232</b>. The release layer can be a low friction film or coating. The release layer may be a thin/flexible fluoropolymer sheet.

<figref idref="DRAWINGS">FIG. 59C</figref> shows that an adhesive layer can be placed on the releaser or directly onto the roller (e.g., if no releaser is used). The adhesive layer may be a thermoplastic film. The adhesive layer may be a thermoset adhesive. The adhesive layer may be a solvated thermoplastic or thermoset.

<figref idref="DRAWINGS">FIG. 59D</figref> shows the application of fiber to the roller. Fiber may be unwound from a spool (not shown) and rolled onto the top surface of the adhesive. The fiber may contain one or more monofilaments. The fiber may have been previously flattened as detailed in this application. Any coating or sizing on the fiber may have been removed using a solvent. The fiber may be placed with a gap between each successive fiber wrap. The gap may be less than 25 um, preferably less than 5 um.

<figref idref="DRAWINGS">FIG. 59E</figref> shows a reinforcement layer on top of the adhesive on top of the release layer.

<figref idref="DRAWINGS">FIG. 59F</figref> illustrates that the roller can be placed between a vacuum top sheet <b>238</b><i>a </i>and a vacuum bottom sheet <b>238</b><i>b</i>, for example in a vacuum bag. A vacuum seal tape <b>240</b> can surround the roller between the vacuum bottom and top sheets. The air can be removed from between the vacuum top and bottom sheets and within the vacuum seal tape, for example by suction from a suction tube <b>242</b>. Inside and/or outside of the vacuum bag, the roller can be heated, for example to melt or cure the adhesive.

<figref idref="DRAWINGS">FIG. 59G</figref> shows the removal of the layer. For instance, a cut may be made substantially perpendicular to the fiber. The layer may be peeled away from the release layer.

<figref idref="DRAWINGS">FIG. 59H</figref> illustrates that the layer of fiber tape can be removed from the roller. For example, the layer can be peeled off the releaser.

The layer can be cut into a pattern. For instance, the layer can be cut with the trimming jig, a laser, a water jet cutter, a die cut tool, or a combination thereof. The layer can be cut to form a strip similar to the one shown in <figref idref="DRAWINGS">FIG. 121</figref>.

<figref idref="DRAWINGS">FIG. 60</figref> illustrates that a strip can be applied to the inner layer or the mandrel. Each strip can be placed around the distal terminal end of the mandrel. The circular section may be centered on the distal end of the mandrel. The strips may be adhered to the mandrel using an adhesive or by melting the adhesive such that it bonds to the underlying layer.

<figref idref="DRAWINGS">FIG. 61</figref> illustrates that a first, second and third strip can be laid onto the mandrel. For example, the strips can be placed on the inner (or another) layer <b>72</b>. The strips can cover the outermost (at the time the strips are applied) layer. The ends of the strips can end on the proximal taper or proximal stem.

<figref idref="DRAWINGS">FIG. 62</figref> illustrates that the circular sections of each strip can line up with each other. The circular sections can be aligned with the balloon distal terminal end. There may be fibers located approximately every 60 degrees at the distal tip

<figref idref="DRAWINGS">FIG. 63</figref> illustrates that fiber can be wound over the mandrel. For example, a tool arm <b>246</b> can be attached to a rotating tool wheel <b>248</b>. The mandrel can be rotated, as shown by arrow <b>252</b>, about the mandrel longitudinal axis <b>250</b> or balloon longitudinal axis. The spool <b>244</b> can be passively (e.g., freely) or actively rotated, as shown by arrow <b>254</b>, deploying the fiber. Before winding, the fiber may be infused with an adhesive, a solvent, or both. A fiber distal end can fix to the top layer or directly to the mandrel. The tool arm <b>246</b> can rotate and translate, as shown by arrows <b>256</b> and <b>258</b>, to track the tool wheel with the surface of the top layer.

The tool wheel can press the fiber against the top layer. The tool wheel can be heated to soften or melt the material on the surface, of the top layer. Another heat source may be used to tack the fiber in place. For example, a separate resistive heater, a laser, or an RF welder may be used. The tool wheel can be made of or coated with a non-stick material. The fiber may be wound with a gap between each successive fiber wind. The gap can be less than about 25 μm, more narrowly less than about 5 μm. The winding process can terminate substantially before reaching the distal tip. The winding process can terminate when the fiber reaches the area where the strips overlap.

The resulting layer deposited in <figref idref="DRAWINGS">FIG. 63</figref> can have a layer thickness of from about 1 μm to about 50 more preferably, 8 μm to about 25 μm.

<figref idref="DRAWINGS">FIG. 64</figref> illustrates that a string, wire or fiber can be helically wrapped around the mandrel, for example on the inner (or another) layer.

<figref idref="DRAWINGS">FIG. 65</figref> illustrates that a rosette, vanes, or spots of a single panel can be placed onto the mandrel. The panel can be made from a metal foil. The rosette may be that shown in <figref idref="DRAWINGS">FIG. 44</figref>. The panel may provide radiopacity to the balloon. The panel may strengthen the balloon. The panel may make the balloon significantly more resistant to puncture.

Any methods of adding a layer to the mandrel or previous layer can be repeated to add additional layers, such as an outer layer of an MMA-resistant film.

The mandrel and the layers, including the panels, strips, wires or fibers, rosette, or combinations thereof, can be adhered, heated and/or pressurized, for example, to melt solvate, or otherwise bond the layers, for example by creating molecular bonds and decreasing the viscosity and modulus of the layers.

<figref idref="DRAWINGS">FIG. 66</figref> illustrates that after the layers of the balloon have been assembled on the mandrel, a distal caul <b>260</b><i>a </i>can be placed over the distal end of the balloon. A proximal caul <b>260</b><i>b </i>can be slid over the mandrel and the proximal end of the balloon. The proximal caul <b>260</b><i>b </i>can be sealed to the distal caul <b>260</b><i>a</i>. The cauls <b>260</b> can be made from a fluoropolymer. The cauls <b>260</b> can have thermoformed FEP with a 0.005 in. initial thickness.

<figref idref="DRAWINGS">FIG. 67</figref> illustrates that the mandrel, balloon and cauls can be placed into a vacuum bag. The balloon proximal stem and/or the mandrel can be placed inside of a vacuum bag. The interior of the vacuum bag can be heated. The vacuum bag can be inserted inside of an oven or autoclave. The layers of the balloon on the mandrel can be thermally cured or melted, for example under from about 1 ATM to about 30 ATM of pressure.

The bag delivery channel can suction the interior of the vacuum bag. For example the pressure in the vacuum bag can be less than about 0.1 ATM.

<figref idref="DRAWINGS">FIG. 68</figref> illustrates that a wash tube <b>264</b> can be inserted into a mandrel washout port <b>262</b>. A dissolving or solvating fluid can be delivered through the wash tube and into the washout port. The mandrel can be removed by delivery of a fluid solvent such as water, alcohol or a ketone. The solvent may be applied during the consolidation process such that the solvent melts or partially softens the mandrel and concurrently pressurizes the bladder. The mandrel can be removed by raising the mandrel to a melting temperature for the mandrel. The mandrel can be removed by deflating the mandrel or by collapsing an internal structure.

The balloon may be expanded under pressure inside of a female mandrel. The mandrel inside diameter may be sized so that a pressurized balloon just contacts the inner wall of the mandrel. Heat may be applied. Heat may cause the wall of the balloon to soften and form against the inside of the female mandrel. This may give the balloon a smoother outer layer and serve to tension the fibers in the balloon.

<figref idref="DRAWINGS">FIG. 69</figref> illustrates that a pleated balloon in an expanded or inflated configuration can be substantially circular in cross-section.

<figref idref="DRAWINGS">FIG. 70</figref> illustrates that a balloon can be clamped in a pleating tool <b>266</b> with two, three, four, five or more removable pleating blocks <b>268</b>. Heating the pleating blocks <b>268</b> to about 80 Celsius and then pressing them against the balloon for about 1 minute causes the balloon to become pleated or fluted. Commercial pleating machines such as balloon folding machinery from Interface Associates (Laguna Niguel, Calif.) can also be used. A small amount of wax may be used to hold the pleated and folded balloon into its desired shape.

<figref idref="DRAWINGS">FIG. 71</figref> illustrates that a pleated balloon in a deflated or contracted configuration can have one or more pleats.

Uni-tape layers can be their own layers.

<figref idref="DRAWINGS">FIG. 72</figref> and <figref idref="DRAWINGS">FIG. 73</figref> illustrate one method of uni-tape fabrication. Tows or bands <b>270</b> provide the extruded monofilaments or fibers <b>86</b> which are optionally passed through a treatment bath <b>272</b> to improve adhesive bonding features of the exterior of the monofilaments via chemical etching, plasma arc etching or corona discharge etching. The pretreated monofilaments from the tows are pulled through an adhesive bath <b>274</b> over and under first rollers <b>232</b><i>a </i>where the matrix adhesive coats and surrounds the monofilaments.

The adhesive-coated monofilaments are drawn through a fixed gap rotary die <b>278</b>. Release material <b>276</b> from second rollers <b>232</b><i>b </i>can be applied to the top and bottom of the adhesive coated monofilaments, for example, prior to the pulling of the tows <b>270</b> through the fixed gap rotary die <b>278</b> which controls adhesive content and spreads the filaments. During a pull-trusion process, the individual tows are laterally joined to form a uni-tape which is heated by a heater <b>280</b> for viscosity change, after which the tape is compacted via rolls third rollers <b>232</b><i>c</i>. The compacted tape can then be passed over a chill plate <b>282</b> to the spool <b>244</b>, with the top sheet of release material being removed at roll fourth roller <b>232</b><i>d </i>and reeled up on fifth roller <b>232</b><i>e. </i>

The monofilaments can be subject to less than about 0.02 pounds of tension during assembly substantially immediately before the monofilaments set in the adhesive matrix. For example, substantially no tensioning can be applied to the monofilaments during manufacturing immediately before the monofilaments set in the adhesive matrix.

Another kind of fiber tape (hereafter referred to as woven tape) may have a woven, knitted or braided fiber cloth, a flexible adhesive, and an optional removable backing or combinations thereof. The removable backing can be made of paper, plastic, film, metal, elastomer, foam, fabric or combinations thereof.

Woven, knitted and braided cloths are known though modern textile products. Typically, weave patterns feature a warp threads, running in a first direction, and weft threads, running in a second direction. The angle between the first and second directions may be 90 degrees. The angle between the first and second directions may be 75 degrees. The angle between the first and second directions may be 60 degrees. The angle between the first and second directions may be 45 degrees. The angle between the first and second directions may be oriented at any appropriate angle. In the process of weaving, the threads may be interlaced in various ways to form weave patterns depending on the properties desired.

Another kind of fiber tape (hereafter referred to as matted tape) can have matted fiber, a flexible adhesive, and an optional removable backing or combinations thereof. The removable backing can be made of paper, plastic, film, metal, elastomer, foam, fabric or combinations thereof. The matted fiber may be a collection of randomly oriented fibers of different lengths.

<figref idref="DRAWINGS">FIG. 74</figref> shows that layers <b>72</b><i>c </i>and <b>72</b><i>d </i>can have reinforcement fibers <b>86</b> oriented in the same direction. This is a 0-0 arrangement, because of the angle that each layer <b>72</b><i>d </i>makes with a vector aligned with the fibers of the bottom layer <b>72</b><i>c</i>. This arrangement may provide twice the strength in the fiber direction as the uni-directional tape itself.

<figref idref="DRAWINGS">FIG. 75</figref> shows that layers <b>72</b><i>c </i>and <b>72</b><i>d </i>can have reinforcement fibers <b>86</b> oriented perpendicular to each other. This is a 0-90 arrangement, because of the angle that the second layer <b>72</b><i>d </i>makes with a vector aligned with the fibers of the bottom layer <b>72</b><i>c</i>. This arrangement may provide substantially the same strength in the 0 degree and 90 degree direction as the uni-directional tape itself.

<figref idref="DRAWINGS">FIG. 76</figref> shows that layers <b>72</b><i>c</i>, <b>72</b><i>d </i>and <b>72</b><i>e </i>can have reinforcement fibers <b>86</b> oriented at 0-0-90 to each other. This arrangement may provide approximately twice the strength in the 0 direction than a single layer of uni-tape provides. This arrangement may provide strength in the 90 direction approximately equal to that of a single uni-tape.

<figref idref="DRAWINGS">FIG. 77</figref> shows that layers <b>72</b><i>c</i>, <b>72</b><i>d</i>, <b>72</b><i>e</i>, <b>72</b><i>f</i>, <b>72</b><i>g</i>, and <b>72</b><i>h </i>can be oriented at 0, 30, 60, 90, −30, −60 respectively to each other.

A laminate may include one or more fiber tapes. A laminate may include one or more polymer films.

The one or more fiber tapes and, optionally, the one or more polymer films can be consolidated into a laminate. Consolidation may include compaction and curing or melting. Compaction can occur before curing or melting. Compaction may include the application of heat and/or light and/or an electron beam, the application of force (i.e., pressure), and the passage of time. Curing or melting may include the application of heat or light, the application of force (i.e., pressure), and the passage of time.

During the process of consolidation, fibers may shift position within the laminate. During the process of consolidation, the fibers may get closer to each other within the laminate.

The polymer film or polymer films may melt during the consolidation process or the polymer films may not melt. The polymer films can be on one or both outer surfaces of the laminate and different materials can be put on each side. The polymer film can be on only one side of the laminate, or absent altogether.

The polymer film could be formed by applying a polymer in a wet application process, such as spraying, dipping, painting, or combinations thereof.

The polymer film may be coated with a material. The coating may be applied by, for instance, sputter coating. The material that is coated on the polymer film may provide substantial radiopacity.

<figref idref="DRAWINGS">FIG. 78</figref> shows an example of the fabrication of a laminate by using an auto clave. Various layers of fiber tape material <b>72</b><i>c</i>, <b>72</b><i>d</i>, and <b>72</b><i>e </i>can be between an outer layer <b>72</b><i>a </i>of a film and an inner layer <b>72</b><i>b </i>of a film. The fiber tape material and the films can be between a top vacuum sheet <b>238</b><i>a </i>and a bottom vacuum sheet. The bottom vacuum sheet can be placed on a rigid plate or platen <b>288</b>. Sealing is provided by seals <b>286</b>. A breather material <b>284</b> may be between the outer layer <b>72</b><i>a </i>and the top vacuum sheet <b>238</b><i>a</i>, for example for evacuating gas from between the vacuum sheets. The enclosed volume or bag between the top and bottom vacuum sheets can be evacuated at the suction tube <b>242</b>.

During the autoclave process as illustrated in <figref idref="DRAWINGS">FIG. 79</figref>, the process steps are first to lay down the bottom vacuum sheet as illustrated at <b>290</b>. Secondly, one optionally lays down the inner layer <b>292</b> to be laminated or consolidated as illustrated at <b>292</b>, followed by the peeling off of the removable backing and laying down the first middle layer as illustrated at <b>294</b>. Thereafter as illustrated at <b>296</b>, optional additional middle layers can be laid down after removal of their removable backing. Additional fiber tape can be laid down in additional directions as needed. Thereafter, the outer layer can be optionally laid down as illustrated at <b>298</b>. A breather material <b>284</b> may be positioned between the outer layer and the and top vacuum sheet. The top vacuum sheet can be laid down over the breather material <b>284</b> as illustrated at <b>300</b>. The structure can be placed in an autoclave as illustrated at <b>302</b>. The volume between the bottom and top vacuum sheets can be evacuated after sealing the edges as illustrated at <b>304</b>.

Thereafter, as part of a consolidation phase, follows a compaction phase as illustrated at <b>306</b> at the requisite pressures and temperatures. Thereafter, as part of a consolidation phase, follows a curing or melt phase as illustrated at <b>308</b> at associated pressures and temperatures.

One set of pressures and temperatures useful for a compaction or cure or melt phase is illustrated in <figref idref="DRAWINGS">FIG. 80</figref> by the temperature time graph and associated temperature pressure graph.

Several laminates, each with different fiber orientations and a different number of layers, may be created. Alternately, a single laminate may be constructed with multiple fiber orientations and layer quantities placed into different regions of the larger laminate. From this single laminate, smaller laminates with specific fiber orientations can then be removed and used to create a medical inflatable.

The choice of a film for the inner or outer surface can provide desirable properties.

If it is desired that the outside of the laminate be low friction and resistant to harm from chemicals, or that the laminate readily release from certain adhesives (such as, for instance, Methyl methacrylate, a principal ingredient in bone cement), a fluoropolymer such as FEP (Fluorinated ethylene propylene) may be selected for the outer layer. One side or both sides of the FEP film may be treated via a plasma method a corona discharge method or via an etchant or by some combination thereof. These treatments may make the fluoropolymer film easily bondable on one or both of its surfaces. The film may also be purchased in a bondable state. A treated surface can form a strong bond with an adhesive, such as the adhesive in the fiber matrix. A surface made bondable may be restored to an unbondable state.

A metal film or foil layer on the outside of the balloon can also be used to resist chemical attack. This metal film or foil layer may give the balloon radiopacity. The outer surface of the balloon may also have a coating that may help the balloon resist chemical attack. The coating may be fluoropolymer based.

The laminate can be made as describe in U.S. Pat. No. 5,333,568 or 5,470,632, both of which are herein incorporated by reference in their entireties.

A layer may be leak tight. The layer may be made by dip molding, for example, urethane or nylon, over a mandrel. The layer may be made by rotational molding.

The layer may be made by coating a substance over the mandrel or the balloon. A coating may be, for instance, parylene. A coating may be a metal, such as gold. A coating may electrodeposited, electroless deposited or via physical vapor deposition or a combination thereof. A coating may have significant radiopacity. A coating may increase the toughness of the balloon, or increase its lubricity. A coating may reduce or eliminate attack or adhesion from chemicals. For instance, a coating may cause the balloon to not be attacked or to adhere to bone cement.

A layer may be formed by conformal coating. A conformal coating may include a fluoropolymer. The coating may be dipped on, sprayed on or applied by electrostatically charging the substrate or by combinations thereof. Coatings may be cured by baking.

A layer may be formed by blow molding. The blow molding process can include a parison. The parision may be open at both ends, or only open at one end (a “blind” parison).

<figref idref="DRAWINGS">FIG. 81A</figref> illustrates that the mandrel can have a spiral groove. The fiber can be wound in the spiral groove. The spiral groove can be on the proximal stem, proximal taper, constant diameter section, distal taper, any steps, or combinations thereof.

<figref idref="DRAWINGS">FIG. 81B</figref> illustrates that the mandrel groove <b>310</b> can be stepped along the length of the mandrel. The fiber can be wound one or more (as shown) times on each step of the groove <b>310</b>.

<figref idref="DRAWINGS">FIG. 81C</figref> illustrates that the mandrel groove <b>310</b> can be bound by groove edges <b>312</b> that can be raised above the level of (i.e., have a larger radius than) the mandrel groove. The groove edge <b>312</b> can interference fit against the fiber. The groove edge height can be equal to or greater than the diameter of the fiber.

<figref idref="DRAWINGS">FIG. 81D</figref> illustrates that the mandrel groove can be configured to receive a second fiber having a second fiber diameter. The second fiber can be wound into the second mandrel groove. A first fiber having a first fiber diameter can be wound between the windings of the mandrel groove. The second fiber can act as a groove edge to the first fiber, interference fitting the first fiber to trap the first fiber between windings of the second fiber. The fibers can have a diameter of from about 0.0005 in. to about 0.004 in. For example the first fiber can have a first fiber diameter of about 0.00075 in. and the second fiber can have a second fiber diameter of about 0.004 in.

<figref idref="DRAWINGS">FIG. 82A</figref> illustrates that a fiber tool <b>314</b> can be used to configure the fiber into a spiral configuration. The fiber tool <b>314</b> can have a fiber tool first part <b>316</b><i>a </i>removably attached to a fiber tool second part <b>316</b><i>b</i>. The fiber tool second part can have a tool axle <b>322</b>. The fiber tool first part can have a tool hub <b>320</b>. The tool axle <b>322</b> can be rotatably and/or removably received by the tool hub <b>320</b>.

The fiber tool <b>314</b> can form a fiber gap <b>318</b> between the fiber tool first part <b>316</b><i>a </i>and the fiber tool second part <b>316</b><i>b</i>. The fiber gap <b>318</b> can have a fiber gap width <b>324</b>. The fiber gap <b>318</b> can be adjusted by, for example, the use of a feeler gauge. The gap width can be from about 15 μm to about 200 μm, more narrowly from about 15 μm to about 100 μm, more narrowly from about 15 μm to about 35 μm. The fiber gap width <b>324</b> can be about, or nominally larger than, the diameter of the fiber.

<figref idref="DRAWINGS">FIG. 82B</figref> illustrates that the fiber can be wound into the fiber gap <b>318</b>. The fiber gap can be straight, for example having a circular configuration. A first release layer and a second release layer may be placed on the inside walls of the fiber gap. An adhesive may be placed in contact with the fiber. The adhesive may be a thermoplastic or a thermoset. The adhesive may be cured or melted. The adhesive may be in place before, during or after the fiber is added to the fiber tool. The adhesive can be a resin. A port (not shown) can be added to the tool such that, under pressure, resin and/or solvent can be infused into the fiber in the gap. The resin and/or solvent can extrude out the perimeter of the gap. The gap can be sealed created a closed volume. The resin and/or solvent can be delivered under pressure into the closed volume of the gap to infuse the fiber.

<figref idref="DRAWINGS">FIG. 83</figref> illustrates that after the adhesive is cured or melted, the fiber tool first part can be removed from the fiber tool second part. The wound fiber and adhesive, as shown, can then be removed from the fiber tool. The wound fiber can have a substantially flat or conical configuration.

<figref idref="DRAWINGS">FIG. 84</figref> illustrates that the fiber gap can be v-shaped in cross-section, for example having a conical configuration.

<figref idref="DRAWINGS">FIG. 85</figref> illustrates the fiber and adhesive panel after coming out the tool pictured in <figref idref="DRAWINGS">FIG. 84</figref>.

<figref idref="DRAWINGS">FIG. 86</figref> illustrates that the wound fiber can be pressure-formed on a mandrel.

<figref idref="DRAWINGS">FIG. 87</figref> illustrates that the shape of the fiber can be distorted by the mandrel to have a wall having a concave, convex or s-curve.

Pressure forming may allow the conical panel to be formed into a shape that more readily matches the shape of a portion of the balloon. The resulting conical panel may be placed onto the balloon and cured or melted into place.

<figref idref="DRAWINGS">FIG. 88</figref> illustrates an alternate method of applying a fiber tape to a balloon <b>20</b>. The balloon <b>20</b> can have continuous laminates that start at a first end of a mandrel, <b>230</b> go to the opposite end of the mandrel <b>230</b> and return to the first end of a mandrel <b>230</b>. The laminate may start substantially at the first end of the mandrel, <b>230</b> or near the first end, for example within 4 mm. The balloon <b>20</b>, the bladder or inner layer, or a mold can be substituted for the mandrel <b>230</b> in this variation.

<figref idref="DRAWINGS">FIG. 89</figref> illustrates that the mandrel can have one or more cross channels <b>328</b> through the mandrel. The cross channels <b>328</b> can have cross channel ports <b>330</b> on the surface of the mandrel. One or more internal restraints can be placed through the mandrel. The restraints may comprise a fiber. A continuous restraint may pass thru one, some or all of the holes in the mandrel

<figref idref="DRAWINGS">FIG. 90</figref> illustrates that the mandrel can have a cross channels that can be parallel with one or more (shown as three) adjacent cross channels. The cross-channels can be curved.

<figref idref="DRAWINGS">FIG. 91A</figref> illustrates that the cross-channel can transect the diametric center of the mandrel. The cross-channel can be straight.

<figref idref="DRAWINGS">FIG. 91B</figref> illustrates that the balloon can have an inner layer and an outer layer. The internal restraint can be fixed to the radial outside of the outer layer.

<figref idref="DRAWINGS">FIG. 91C</figref> illustrates that the internal restraint can be fixed between the inner layer and the outer layer.

<figref idref="DRAWINGS">FIG. 91D</figref> illustrates that the internal restraint can be fixed to the radial inside of the inner layer.

<figref idref="DRAWINGS">FIG. 92</figref> illustrates a portion of an alternate process for applying fiber tape to a mandrel. <figref idref="DRAWINGS">FIG. 92</figref> illustrates that the first, second, third and fourth strips <b>192</b><i>a</i>, <b>192</b><i>b</i>, <b>192</b><i>c</i>, and <b>192</b><i>d </i>may have one or more layers of uni-tape oriented along the long axis of the laminate (this fiber orientation is shown in the figure). The strips <b>192</b> can be rectangular. The strips <b>192</b> can have adhesive. Each strip may be oriented parallel to the mandrel longitudinal axis or balloon longitudinal axis. Enough strips can be used such that the strips encircle the mandrel's largest diameter. The strips may overlap each other. The mandrel can have one or more layers on the mandrel before the strips are applied.

<figref idref="DRAWINGS">FIG. 93</figref> illustrates that a panel may be applied to a mandrel with none, one or more layers on the mandrel. The panel can have one or more layers of uni-tape oriented along the long edge panel longitudinal edge <b>332</b>. The panel can have a panel width <b>334</b>. The panel can have a panel rectangular section <b>336</b> and one or more panel serrations <b>338</b>. The angle between the serrations <b>338</b> can be a panel serration angle <b>340</b>. The panel serration angle <b>340</b> can be about 30°, about 20°, about 10°, or about 0°. The panel longitudinal edge can be oriented parallel to the mandrel longitudinal axis or the balloon longitudinal axis. Parts of the panel may overlap other parts of the panel.

<figref idref="DRAWINGS">FIG. 94</figref> illustrates that the panel can be applied to a mandrel with none, one or more layers on the mandrel. The panel can have one or more layers of uni-tape oriented perpendicular to the panel longitudinal edge <b>332</b>. The panel can have multiple layers of uni-tape oriented at different angles in the panel (not shown). The uni-tape may make angles (not shown) of about 30°, about 45°, or about 60° with panel longitudinal edge <b>332</b>.

The panel width can be more than about three times the circumference of the balloon, layer or mandrel. The panel can be wrapped around the balloon, layer or mandrel about three times. The panel width can be more than about five times the circumference of the balloon, layer or mandrel. The width can be more than about ten times the circumference of the balloon, layer or mandrel.

<figref idref="DRAWINGS">FIG. 95</figref> illustrates that a first panel <b>196</b><i>a </i>can have eight serrations and a panel latitudinal edge <b>333</b>. The first panel <b>196</b><i>a </i>can be a laminate of resin and fiber, as described herein. A first line <b>346</b><i>a </i>can be marked on the surface of the first panel <b>196</b><i>a </i>and may be parallel to the latitudinal edge <b>333</b> and located about 3 mm from the latitudinal edge <b>333</b>. The first panel <b>196</b><i>a </i>can have a panel bottom edge <b>344</b> and the panel longitudinal edge <b>332</b>. The panel bottom edge <b>344</b> can have a length of about 58 mm (2.3 in.). The panel longitudinal edge <b>332</b> can have a length of about 50 mm in length. The distance from the serration tip <b>342</b> to the first line <b>346</b><i>a </i>can be about 16 mm. The distance from the panel bottom edge <b>344</b> to the first line <b>346</b><i>a </i>can be about 47 mm. The second line <b>346</b><i>b </i>can be marked on the surface of the panel. The second line <b>346</b><i>b </i>can be perpendicular to first line <b>346</b><i>a</i>. The second line <b>346</b><i>b </i>can intersect a serration tip <b>342</b>. The second area <b>348</b><i>b </i>of the panel below the first line <b>346</b><i>a </i>can have four unidirectional reinforcement fiber tapes laid sequentially in the 0 degree direction. The second area <b>348</b><i>b </i>can have two uni-tapes laid sequentially in the 90 degree direction. The first area <b>348</b><i>a </i>of the panel above the first line <b>346</b><i>a </i>can have two uni-tapes oriented sequentially in the 0 degree direction and two uni-tapes oriented sequentially in the 90 degree direction.

<figref idref="DRAWINGS">FIG. 96</figref> illustrates that a second panel <b>196</b><i>b </i>can be circular. The second panel <b>196</b><i>b </i>can be about 28 mm in diameter and can have about four slits or cuts <b>350</b>. Each cut <b>350</b> can be about 7 mm long. Four tabs <b>352</b> can be formed by the cuts <b>350</b>. The second panel can have one each of the uni-tapes oriented sequentially at each of 0°, 30°, 60°, 90°, −30°, and −60° angles.

<figref idref="DRAWINGS">FIG. 97</figref> illustrates that a third panel <b>196</b><i>c </i>can be shaped like a parallelogram with first side edge <b>356</b><i>a </i>parallel to second side edge <b>356</b><i>b </i>and third side edge <b>356</b><i>c </i>parallel to fourth side edge <b>356</b><i>d</i>. The first side edge <b>356</b><i>a </i>can form an acute angle with third side edge <b>356</b><i>c </i>of about 70°. The first side edge <b>356</b><i>a </i>can be about 13 mm long. The third panel <b>196</b><i>c </i>can have one uni-tape oriented in about the 0° direction and one uni-tape oriented in about the 90° direction.

<figref idref="DRAWINGS">FIG. 98</figref> illustrates that a fourth panel <b>196</b><i>d </i>can be rectangular. The fourth panel <b>196</b><i>d </i>can have first and second long edges <b>358</b><i>a </i>and <b>358</b><i>c </i>and first and second short edges <b>358</b><i>b </i>and <b>358</b><i>d</i>. The long edges <b>358</b><i>a </i>and <b>358</b><i>c </i>can be about 58 mm. The short edges <b>358</b><i>b </i>and <b>358</b><i>d </i>can be about 3 mm long. The fourth panel can have about three uni-tapes oriented sequentially in about the 0° direction and about one uni-tape oriented about in the 90° direction.

<figref idref="DRAWINGS">FIG. 99</figref> illustrates that the fifth panel <b>196</b><i>e </i>can have panel serrations <b>338</b> and a panel latitudinal edge <b>333</b>. The first line <b>346</b><i>a </i>can be marked on the surface of the fifth panel <b>196</b><i>e </i>and may be parallel to the latitudinal edge <b>333</b> and located about 8 mm from latitudinal edge <b>333</b>. The fifth panel can have a bottom edge <b>344</b> about 57 mm in length. The distance from the tip of the serrations to the dotted line can be about 7 mm. The distance from the bottom edge to the dotted line can be about 43 mm. The second area <b>348</b><i>b </i>of the panel below the first line <b>346</b><i>a </i>may have four uni-tapes oriented sequentially in the 0° direction and two uni-tapes oriented sequentially in the 90° direction. The first area <b>348</b><i>a </i>of the panel above the first line can have two uni-tapes oriented sequentially in the 0° direction and two uni-tapes oriented sequentially in the 90° direction.

<figref idref="DRAWINGS">FIG. 100</figref> illustrates that the sixth panel <b>196</b><i>f </i>can have a circular edge <b>360</b> with a radius of curvature of about 20 mm. The sixth panel <b>196</b><i>f </i>can have panel first and second radial edges <b>362</b><i>a </i>and <b>362</b><i>b </i>that connect to the panel circular edge <b>360</b> and connect to the center of the radius of curvature of the panel circular edge <b>360</b>. The sixth panel can have one each of the uni-tapes oriented sequentially at each of 0°, 30°, 60°, 90°, −30°, and −60° with respect to each other.

<figref idref="DRAWINGS">FIG. 101</figref> illustrates that the mandrel <b>230</b> can have a mandrel constant diameter section <b>370</b> of about 17.07 mm in diameter and about 76 mm in length. The mandrel <b>230</b> can have a mandrel transition <b>366</b> where the first constant diameter section meets the distal taper approaching the mandrel terminal distal end <b>372</b>. The mandrel <b>230</b> can have a mandrel stem <b>364</b> and mandrel proximal taper <b>368</b>. The mandrel <b>230</b> can have mandrel transition <b>366</b> where the proximal taper <b>368</b> meets the mandrel constant diameter section <b>370</b>. The mandrel <b>230</b> can have a mandrel transition <b>366</b> where the radius stem <b>416</b> meets transition radius. The mandrel can have transitions <b>366</b> between lengths.

<figref idref="DRAWINGS">FIG. 102</figref> illustrates that the first panel <b>196</b><i>a </i>can be wrapped around the distal end of the mandrel <b>230</b>. The first line <b>346</b><i>a </i>can be aligned with mandrel transition <b>366</b> at the distal end of the mandrel <b>366</b>. Adhesive can be placed in the region of overlap seam <b>66</b> to secure the panel on the mandrel. The adhesive can hold the panel closed around the mandrel. Standard cellophane tape <b>374</b> (also element <b>343</b>) can secure the panel to the mandrel. Adhesive may next be applied to completely cover the outer surface of the serrations. Every other serration can be first folded over the mandrel distal taper. The remaining serrations can then be folded onto the mandrel distal taper.

<figref idref="DRAWINGS">FIG. 103</figref> illustrates the mandrel <b>230</b> with the first panel <b>196</b><i>a </i>applied to the mandrel <b>230</b> as described infra and in <figref idref="DRAWINGS">FIG. 73</figref>.

<figref idref="DRAWINGS">FIG. 104</figref> illustrates that the second panel <b>196</b><i>b </i>can be centered on top of the distal taper. Any cut <b>350</b> in the panel can be aligned with the second line <b>346</b><i>b </i>on the first panel <b>356</b><i>a</i>. The four tabs <b>352</b> of the second panel can be folded over the serrations <b>338</b>.

<figref idref="DRAWINGS">FIG. 105</figref> illustrates the mandrel with the first and second panels <b>196</b><i>a </i>and <b>356</b><i>b </i>applied to the mandrel as described herein.

<figref idref="DRAWINGS">FIG. 106</figref> illustrates that the fourth panel <b>196</b><i>d </i>can have adhesive applied to one surface. Second long edge <b>358</b><i>c </i>of the fourth panel <b>196</b><i>d </i>can be aligned with the first line <b>346</b><i>a </i>on the first panel <b>196</b><i>a</i>. The first long edge <b>358</b><i>a </i>can be positioned proximal to the first line <b>346</b><i>a</i>. The fourth panel <b>196</b><i>d </i>can be wrapped around the mandrel, with the adhesive on the fourth panel facing toward the mandrel. The balloon second section <b>384</b><i>b </i>can be removed from the mandrel.

<figref idref="DRAWINGS">FIG. 107</figref> illustrates that the balloon second section <b>384</b><i>b</i>. The distal balloon fragment can have balloon outer diameter <b>50</b>.

<figref idref="DRAWINGS">FIG. 108A</figref> illustrates that the female mold <b>376</b> can be made of a first mold half <b>378</b><i>a </i>and a second mold half <b>378</b><i>b</i>. When the two mold halves <b>378</b><i>a </i>and <b>378</b><i>b </i>are brought together, they can form a center mold lumen <b>380</b> where the second balloon section <b>384</b><i>b </i>may be placed in the mold <b>376</b>. A mold port <b>382</b> in mold second half <b>378</b><i>b </i>is in fluid communication with the mold lumen <b>380</b>. The mold port <b>382</b> can be used to connect a vacuum pump when curing a balloon fragment. The balloon fragment <b>384</b> can be placed in the mold lumen <b>380</b>.

<figref idref="DRAWINGS">FIG. 108B</figref> illustrates that an optional first releaser <b>236</b><i>a </i>can be applied to the inside of the female mold <b>376</b>. The first releaser <b>236</b><i>a </i>can be a grease, a non-stick film or a non-stick tape or sheet. A second releaser <b>236</b><i>b </i>can be placed on top of the balloon fragment <b>384</b>. This second mold releaser or release agent can be a grease or a non-stick film. A breather material <b>284</b> can next be placed for purposes of equalizing the pressure during a curing cycle. A vacuum bag or top vacuum sheet and a seal can be installed. The mold port can forms a fluid connection from outside the mold to the space between the vacuum bag or top vacuum sheet and the inner wall of the female mold. This fluid connection can remain unobstructed by the first mold releaser or release agent, balloon fragment <b>384</b>, second mold release agent, and breather material <b>284</b>, when a vacuum pressure is applied to the mold port. The distal balloon fragment <b>384</b> may be consolidated.

<figref idref="DRAWINGS">FIG. 109</figref> illustrates that the third panel <b>196</b><i>c </i>can be coated on one side with adhesive. The third panel <b>196</b><i>c </i>may be wrapped around the mandrel stem with the adhesive side facing away from the mandrel stem. The third panel <b>196</b><i>c </i>can be wrapped such that the fourth side edge <b>356</b><i>d </i>is approximately coincident with the mandrel transition from the mandrel stem to the mandrel proximal taper.

<figref idref="DRAWINGS">FIG. 110</figref> illustrates that the fifth panel <b>196</b><i>e </i>can be wrapped around the proximal end of the mandrel. The serrations can point in the proximal direction. The first line <b>346</b><i>a </i>may be aligned about 7 mm proximal to the transition between the mandrel proximal taper and the mandrel constant diameter section. The first line <b>346</b><i>a </i>can be aligned parallel to the mandrel transition. Adhesive can be applied on the panel where the panel overlaps with itself. Adhesive can be applied to completely cover the surface of the serrations that face out from the mandrel. Every other serration may first folded over the proximal taper. Then the remaining serrations may be folded onto the cone.

<figref idref="DRAWINGS">FIG. 111</figref> illustrates that the sixth panel <b>196</b><i>f </i>may be wrapped over the proximal taper. the sixth panel, when wrapped around the proximal taper can cover more than about 2 mm of the mandrel stem and more than about 2 mm of the mandrel constant diameter section.

<figref idref="DRAWINGS">FIG. 112</figref> illustrates that the balloon first and second sections <b>384</b><i>a </i>and <b>384</b><i>b </i>can be slid together such that they overlap by about 6 mm. An adhesive can be placed in the overlap region or seam. The first and second balloons sections and adhesive may be placed in a female mold. A compliant balloon or bladder may be inserted inside the balloon fragments. The balloon may be consolidated to form a fiber reinforced balloon, 10 and 20, capable of sustaining pressure.

<figref idref="DRAWINGS">FIG. 113</figref> illustrates that a second balloon fragment <b>284</b><i>b </i>that can have the third, fifth and sixth panels <b>196</b><i>c</i>, <b>196</b><i>e</i>, and <b>196</b><i>f </i>combined. The proximal balloon fragment may be placed under vacuum in a female mold and consolidated.

The longitudinal length <b>388</b> of the constant diameter section of second balloon section <b>384</b><i>b </i>can be trimmed to about 9 mm long.

<figref idref="DRAWINGS">FIG. 114</figref> illustrates that a solid release film (not shown) such as Teflon may be inserted into the interior of the balloon. The first and second balloon sections <b>384</b><i>a </i>and <b>384</b><i>b </i>can be clamped together by clamps <b>386</b>. The balloon sections <b>384</b> can be consolidated to form a fiber reinforced balloon <b>20</b> capable of sustaining pressure.

Additional laminates can be added to areas of a balloon that might require extra strength for certain procedures or uses. A balloon may have different amounts of fiber, adhesive or polymer film in different portions of the balloon wall. A balloon may have different number of fiber layers in different portions of the balloon wall.

<figref idref="DRAWINGS">FIG. 115</figref> illustrates a variation of the assembled device.

<figref idref="DRAWINGS">FIG. 116</figref> illustrates that a first panel of polymer can rest on top of the female mold half (The first panel can be a see-through polymer for illustrative purposes, for example the contours of the mold may be seen.) The first panel can be a polymer, such as a nylon, PET, polycarbonate, urethane or any other polymer that can be readily formed. The first panel be about 0.002 inches thick, more narrowly about 0.001 inches thick, yet more narrowly about 0.0005 inches thick.

<figref idref="DRAWINGS">FIG. 117</figref> illustrates that the first panel can be formed to the contours of mold.

<figref idref="DRAWINGS">FIG. 118</figref> illustrates that the first panel can be lifted free of the mold. The first panel can have a panel flat <b>390</b> that did not enter the form of the female mold during forming. The panel can be trimmed, for example in a trimming jig.

<figref idref="DRAWINGS">FIG. 119</figref> illustrates that first and second panels can have their flats <b>390</b> trimmed. The two panels can be closed tightly around a mandrel and a mandrel shaft <b>392</b>. The panels can then be bonded to each other at the point where they overlap. The bond may connect all or some of the material that overlaps. The bond may be leak tight to the passage or air and water. Bonding may take place by addition of an adhesive, by the application of heat, by the application of ultrasonic energy, by use of a laser, by the application of radio frequency energy, by the application of pressure or by combinations thereof. A material may be added to the joint that enhances the effectiveness of these bonding techniques.

<figref idref="DRAWINGS">FIG. 120</figref> illustrates that inner layer may be constructed over a mandrel which is not removable. The inner layer can be constructed inside a female mold (not shown) that matches the intended outer shape of the inner layer. Both a mandrel and a female mold may be used together to create a narrow thickness for the inner layer to be formed in. The inner layer may be thermoformed, or injection molded or constructed via some other method listed supra. The inner layer can be slit <b>394</b>, removed from the non-removable mandrel and placed over a removable mandrel (as described above). The slit <b>394</b> can then be patched with a thin strip of polymer attached to inner layer.

An inner layer may be formed by a standard blow molding process such as extrusion blow molding, injection blow molding, or stretch blow molding. The inner layer may be checked for leaks before being used.

<figref idref="DRAWINGS">FIG. 121</figref> illustrates that a strip <b>192</b> can be an elongated element of polymer film, metal foil or fiber tape cut into a shape that may be useful in creating a fiber reinforced balloon. The shape of the strip <b>192</b> may be cut by hand, with a high pressure water jet or with a laser. Extending longitudinally from a first end of the strip <b>192</b> to a second end of the strip <b>192</b>, the strip <b>192</b> can have a first narrow section <b>396</b><i>a</i>, a first taper, a first wide section <b>398</b><i>a</i>, a first central narrowing, a circular section <b>402</b>, a second central narrowing, a second wide section <b>398</b><i>b</i>, a second taper, and a second narrow section <b>396</b><i>b</i>. The strip can have one or more reinforcement fibers. The reinforcement fibers can be substantially aligned with the strip longitudinal axis. For example, the strip <b>192</b> can have uni-tape. The strip <b>192</b> can have one or more layers. The reinforcement fibers can extend the entire length of the strip <b>192</b>. A polymer film (not shown) can on one side or both sides of the strip <b>192</b>. The strip <b>192</b> can be flexible before and after consolidation.

<figref idref="DRAWINGS">FIG. 122</figref> illustrates that fibers in strip <b>192</b> can be uni-directional and can be substantially aligned with the strip longitudinal axis. The strip can be substantially rectangular. A polymer film (not shown) can be placed on one side or both sides of the strip <b>192</b>. The strip <b>192</b> can be flexible before and after consolidation.

<figref idref="DRAWINGS">FIG. 123</figref> illustrates that a first, second and third strip <b>192</b><i>a</i>, <b>192</b><i>b</i>, and <b>192</b><i>c </i>can be aligned at equal strip angles <b>404</b> to each other to form a rosette. The strip angle <b>404</b> can be the angle from the first strip longitudinal axis to the adjacent strip longitudinal axis. The circular section <b>402</b> for each strip <b>192</b> can be substantially concentric to the circular sections for the other strips <b>192</b>.

<figref idref="DRAWINGS">FIG. 124</figref> illustrates that the strips <b>192</b> can have no reinforcement fibers.

<figref idref="DRAWINGS">FIG. 125</figref> illustrates that strip can be applied to the inner layer (e.g., bladder). The inner layer can have a hard mandrel inside of the inner layer. The mandrel can support the surface of the inner layer. The circular section <b>402</b> of the strip can be concentrically aligned with the terminal distal end of the inner layer and adhered in place. The remainder of strip can be laid over the contours of inner layer or bladder such that narrow sections of fiber tape partially cover stem on bladder.

Several pieces of fiber tape may be applied to bladder. Each piece may be concentrically aligned with the tip of the distal end of the bladder and adhered in place. However, alignment may be such that the fiber tape cover sections of bladder and shaft that have not yet been covered with fiber tape or have not yet been covered with fiber tape with fibers in substantially similar orientations. Two to eight pieces of fiber tape may be applied in this manner. Application may continue until all of bladder <b>72</b><i>b </i>is covered in fiber tape with fibers substantially oriented along the long axis of the mandrel and stem.

<figref idref="DRAWINGS">FIG. 126</figref> illustrates that fiber tape may be applied to a flexible bladder or inner layer. The bladder can be supported by the presence of mandrel inside of it. Fiber tape may be wrapped from two to eight times around the largest diameter of the bladder. <figref idref="DRAWINGS">FIG. 210</figref> shows fiber tape wrapping more than three and less than four times around bladder. At the end of this wrapping procedure, fiber tape may be tightly wrapped around the largest diameter of mandrel.

<figref idref="DRAWINGS">FIG. 127</figref> illustrates that fiber may be wound around flexible bladder or inner layer. Bladder may be supported by the presence of mandrel inside of it. Fiber <b>86</b> may be uni-directional fibers with or without adhesive. Fiber may be a continuous piece of fiber. Fiber <b>86</b> may be wrapped over a portion or all of bladder. Adhesive may be applied to bladder <b>72</b> before application of the fiber, during application of the fiber or after application of the fiber or some combination thereof.

Successive layers of fiber may be used to build a completed balloon. Three pieces of fiber tape may be applied to bladder <b>72</b>. This may be followed by the application of fiber tape substantially over the main diameter. This may be followed by application of fiber <b>86</b> on a portion or all of the proximal taper and stem of the bladder. This may be followed by application of fiber <b>86</b> on a portion or all of the distal tip of the bladder. Lastly, a layer of PEN film may be applied. Layers of fiber tape or fiber may be omitted from this sequence. Layers of fiber tape and fiber can be applied in any order. Polymer film may be applied between layers, over the bladder or over the final layer of fiber or fiber tape.

<figref idref="DRAWINGS">FIGS. 128A and 1288</figref> illustrate that the unconsolidated balloon may be placed in a female mold <b>376</b>. The unconsolidated balloon can include the shaft <b>2000</b>, mandrel <b>230</b>, bladder <b>72</b> and the various layers of fiber, fiber tape and film. The female mold <b>376</b> may contain a pocket for the unconsolidated balloon that is slightly larger than the unconsolidated balloon.

<figref idref="DRAWINGS">FIG. 128C</figref> illustrates that the lower portion of <figref idref="DRAWINGS">FIG. 104</figref> is a portion of mandrel <b>230</b> and the upper portion of <figref idref="DRAWINGS">FIG. 104</figref> is a portion of female mold <b>376</b>. The various layers of fiber, fiber tape and film can be spaced from the surface of the mold <b>376</b>. This distance may be from about 0.005 in. to about 0.050 in. When the bladder <b>72</b> is inflated, the layers <b>72</b> can detach from the mandrel <b>230</b> and press firmly against the walls of the female mold <b>376</b>.

<figref idref="DRAWINGS">FIG. 128C</figref> shows the layers after detaching from mandrel <b>230</b> but before being pressed against female mold <b>376</b>. This inflation and expansion may serve to straighten and/or tension the fibers. Heat or light or an electron beam or a combination thereof may be used with the inflation of bladder <b>72</b><i>b </i>and the passage of time to consolidate a fiber reinforced balloon. Light or an electron beam may be applied, as part of a consolidation, by inserting a source within a hollow lumen in a mandrel. The mandrel can then be removed as described infra.

Method of Use

The device <b>2</b>, for example including the balloon <b>20</b>, can be used for Kyphoplasty, angioplasty including CTO dilation, stent delivery, sinuplasty, valvuloplasty, drug or other fluid delivery through the balloon, radiopaque marking, incising the inside of a vessel (e.g., to open or expand a vessel), brachytherapy, intentionally obstruct a vessel, or combinations thereof. The device <b>2</b> can be used to deliver one or more stents and/valves and/or emboli filters to the coronary blood vessels (e.g., arteries or veins), carotid artery, peripheral blood vessels, the GI tract, the biliary ducts, the urinary tract, the gynecologic tract, and combinations thereof. The device <b>2</b> can be used to prepare a cardiac annulus and/or the leaflets of a natural heart valve for open or percutaneous (minimally invasive) valve replacement. The device <b>2</b> can expand and deploy a percutaneously delivered heart valve

<figref idref="DRAWINGS">FIG. 129</figref> illustrates a sagittal view of a patient and the spine <b>406</b>. The spine <b>406</b> can have vertebrae <b>408</b> and cervical, thoracic, lumbar and sacral regions <b>410</b>, <b>412</b>, <b>414</b>, and <b>416</b>. The device <b>2</b> can be used in or between vertebrae <b>408</b> in any region of the spine <b>406</b>.

<figref idref="DRAWINGS">FIG. 130</figref> illustrates a vertebrae <b>408</b> that can have cortical bone <b>418</b> and cancellous bone <b>420</b>. The vertebrae <b>408</b> can have a vertebral body <b>422</b> a vertebral process <b>424</b> and pedicles <b>426</b>.

<figref idref="DRAWINGS">FIG. 131</figref> illustrates a vertebra that a delivery tube <b>428</b>, such as a cannula, can be inserted against or into the pedicle. The delivery tube <b>428</b> may have a inside diameter of less than about 6 mm, more narrowly from about 2 mm to about 4.5 mm. A bone drill can be passed through the delivery tube <b>428</b> to drill to create a drill void <b>430</b> in the cancellous bone. The bone drill can then be removed leaving the drill void <b>430</b> in the cancellous bone.

<figref idref="DRAWINGS">FIG. 132</figref> illustrates a cross section of a balloon <b>20</b>. The balloon <b>20</b> can be in a substantially inflated condition. The cross section area is shown. The balloon wall can have a balloon wall area <b>432</b>.

<figref idref="DRAWINGS">FIG. 133</figref> illustrates a cross section of balloon <b>20</b> in a substantially deflated and folded configuration. The balloon <b>20</b> is shown in a delivery tube or cannula with a delivery tube inside diameter <b>436</b> and a delivery tube area <b>434</b>. The balloon <b>20</b> may be able to slide in the cannula.

The compression ratio of the balloon can be from about 3:1 to about 6:1, more narrowly from about 4:1 to about 5:1. The compression ratio can be the ratio between the outside diameter of the substantially inflated balloon (e.g., as shown in <figref idref="DRAWINGS">FIG. 132</figref>) and the inside diameter of the delivery tube (e.g., the cannula as shown in <figref idref="DRAWINGS">FIG. 133</figref>).

The balloon can have a packing density equal to or greater than about 40%, more narrowly greater than or equal to about 55%, yet more narrowly equal to or greater than about 70%. The packing density can be the percentage ratio between the cross sectional area of the walls of the balloon and the cross sectional area of the inside of the cannula.

The packing density and compression ratios for the balloon can remain substantially constant and the wall strength of the balloon can remain substantially constant with repeated packing and unpackings, and/or compressings and uncompressings.

The balloon can be folded into the cannula and expanded about eight times while not significantly degrading the strength of the balloon wall.

<figref idref="DRAWINGS">FIG. 134</figref> illustrates that the balloon can be inserted, as shown by arrow, through the delivery tube and into the drill void in the cancellous bone.

<figref idref="DRAWINGS">FIG. 135</figref> illustrates that fluid pressure can be delivered, as shown by arrow <b>438</b>, through the hollow shaft <b>2000</b> to the balloon <b>20</b>. The balloon <b>20</b> can inflate and expand, as shown by arrows <b>440</b>. The expanding balloon can compress the cancellous bone surrounding the drill void, creating a larger balloon void <b>442</b>. The balloon <b>20</b> can be deflated and contracted. The balloon can be removed from the vertebral body and the delivery tube.

<figref idref="DRAWINGS">FIG. 136</figref> illustrates that the diametric elasticity of existing medical inflatable devices can be approximately 0.06 in./ATM and a typical burst pressure is about 3 ATM. The medical inflatable device <b>2</b> can have an exemplary diametric elasticity of 0.0004 in./ATM and a burst pressure above 20 ATM (290 psi). For example, the burst pressure can be from about 290 psi to about 1500 psi. More narrowly, the burst pressure can be from about 500 psi to about 1000 psi. For example, the burst pressure can be about 500 psi, about 750 psi, about 1000 psi, about 1500 psi, or higher than 1500 psi. For example, the burst pressure can be greater than 4 ATM with a diameter of greater than 20 mm, with a diametric compliance of less than about 15%, or less than about 10% or less than 5%.

<figref idref="DRAWINGS">FIG. 137</figref> illustrates that a hollow balloon void <b>442</b> can be formed within the cancellous bone of the vertebral body. The balloon void <b>442</b> can remain in place when the balloon <b>20</b> is withdrawn from the vertebral body.

<figref idref="DRAWINGS">FIG. 138</figref> illustrates that a cement conduit <b>444</b> can be inserted, as shown by arrow <b>446</b>, through the delivery tube and into the balloon void. A filler, such as a bone cement <b>445</b>, can be inserted, as shown by arrow <b>448</b>, into the balloon void <b>442</b>.

<figref idref="DRAWINGS">FIG. 139</figref> illustrates that additional bone cement <b>445</b> can be delivered through the cement conduit <b>444</b> to the balloon void <b>442</b>.

<figref idref="DRAWINGS">FIG. 140</figref> illustrates that the balloon void can be substantially filled with the bone cement. The bone cement can cure. The cement conduit can be removed. The delivery tube can be removed.

<figref idref="DRAWINGS">FIGS. 141A through 141C</figref> illustrate a method of creating an initial balloon void with a first balloon similar to the methods shown herein. The first balloon <b>20</b><i>a </i>can create an initial balloon void <b>442</b><i>a </i>in the cancellous bone.

<figref idref="DRAWINGS">FIG. 141D</figref> illustrates that the pressure can be removed, as shown by arrow <b>450</b>, and/or suction, can be applied through the first hollow shaft. The first balloon <b>20</b><i>a </i>can deflate and contract, as shown by arrows <b>452</b>. The first balloon <b>20</b><i>a </i>can be left in the initial balloon void. The first hollow shaft can be pushed to the side of the delivery tube.

<figref idref="DRAWINGS">FIG. 141E</figref> illustrates that a second balloon attached to a second hollow tube can be inserted, as shown by arrow, through the delivery tube <b>428</b> and into the initial balloon void <b>442</b><i>a</i>. The second balloon can be placed adjacent to the first balloon.

<figref idref="DRAWINGS">FIG. 141F</figref> illustrates that a first pressure can be delivered, as shown by arrow <b>438</b><i>a</i>, through the first hollow shaft and into the first balloon. The first balloon can undergo a first balloon final expansion, as shown by arrows <b>440</b><i>a</i>. Before, concurrent with, or subsequent to the first balloon final expansion, a second pressure can be delivered, as shown by arrow <b>438</b><i>b</i>, through the second hollow shaft and into the second balloon <b>20</b><i>b</i>. The second balloon can undergo a second balloon expansion, as shown by arrows <b>440</b><i>b</i>. The first balloon final expansion and the second balloon expansion can create a final balloon void <b>442</b><i>b </i>in the cancellous bone.

<figref idref="DRAWINGS">FIG. 141G</figref> illustrates that the first and second balloons can be deflated, contracted and removed from the final balloon void <b>442</b><i>b</i>. The final balloon void can remain in place with the balloons removed. The final balloon void can be larger than the initial balloon void.

<figref idref="DRAWINGS">FIG. 141H</figref> illustrates that a cement conduit can be inserted, as shown by arrow, through the delivery tube and into the balloon void. A filler, such as a bone cement, can be inserted into the final balloon void.

<figref idref="DRAWINGS">FIG. 141<i>i </i></figref>illustrates that the final balloon void can be substantially filled with the bone cement. The bone cement can cure. The cement conduit can be removed. The delivery tube can be removed.

<figref idref="DRAWINGS">FIGS. 142A through 142C</figref> illustrate a method of created a balloon void with a balloon similar to the methods shown herein. The hollow shaft can be attached to a cement conduit.

<figref idref="DRAWINGS">FIG. 142D</figref> illustrates that the bone cement can be delivered through the cement conduit and into the balloon void. The balloon can be deflated and contracted, as shown by arrows, and/or the balloon can be pushed out of the way by pressurized bone cement delivered into the balloon void. The bone cement can contact the balloon with or without significantly decaying, eroding or bonding to the balloon wall.

<figref idref="DRAWINGS">FIG. 142E</figref> illustrates that additional bone cement can be delivered to the balloon void as the balloon contracts. The bone cement can partially or completely cure with our without being in contact with the balloon. The balloon wall can peel away or otherwise be separated from cured or uncured bone cement.

<figref idref="DRAWINGS">FIG. 142F</figref> illustrates that the final balloon void can be substantially filled with the bone cement. The bone cement can cure. The hollow shaft and cement conduit can be removed. The delivery tube can be removed.

<figref idref="DRAWINGS">FIGS. 131 through 142F</figref> illustrate that the one or more balloons can be inserted into the vertebral body unilaterally, through a pedicle on one lateral side of the vertebra.

<figref idref="DRAWINGS">FIGS. 143A through 143</figref><i>i </i>illustrate a method for deploying the balloons bilaterally, for example including one balloon inserted through each of opposing pedicles <b>426</b><i>a </i>and <b>426</b><i>b. </i>

<figref idref="DRAWINGS">FIG. 143A</figref> illustrates that a first delivery guide <b>428</b><i>a </i>can be through the left pedicle <b>426</b><i>a</i>. A first drill void <b>430</b><i>a </i>can be formed on the left side of the vertebral body. A second delivery guide <b>428</b><i>b </i>can be through the right pedicle <b>426</b><i>b</i>. A second drill void <b>430</b><i>b </i>can be formed on the left side of the vertebral body.

<figref idref="DRAWINGS">FIG. 143B</figref> illustrates that a first balloon <b>20</b><i>a </i>can be inserted into the left side of the vertebral body through the first delivery tube <b>428</b><i>a</i>. A second balloon <b>20</b><i>b </i>can be inserted into the right side of the vertebral body through the second delivery tube <b>428</b><i>b. </i>

<figref idref="DRAWINGS">FIG. 143C</figref> illustrates that the first balloon <b>20</b><i>a </i>can be inserted through the first delivery tube <b>428</b><i>a</i>. The second balloon <b>20</b><i>b </i>can be inserted through the second delivery tube <b>428</b><i>b</i>. The first and second balloons can be inflated and expanded. The first and second balloons can form a first void segment <b>454</b><i>a </i>and a second void segment <b>454</b><i>b</i>, respectively, of the balloon void <b>442</b>. The void segments <b>454</b> may overlap, as shown. The void segments <b>454</b> may be separate.

<figref idref="DRAWINGS">FIG. 143D</figref> illustrates that the second balloon can be deflated, contracted and removed from the balloon void.

<figref idref="DRAWINGS">FIG. 143E</figref> illustrates that a second cement conduit can be inserted through the second delivery tube and into the second void segment. Bone cement can be delivered through the second cement conduit and into the second void segment.

<figref idref="DRAWINGS">FIG. 143F</figref> illustrates that the bone cement can fill the second void segment and/or contact the first balloon. The second cement conduit can be removed from the balloon void. The bone cement delivered to the second void segment can cure. The first balloon may not erode, decay or bond to the cement.

<figref idref="DRAWINGS">FIG. 143G</figref> illustrates that the first balloon can be deflated, contracted and withdrawn from the first void segment. The first void segment can be empty. The second void segment can be substantially filled with bone cement.

<figref idref="DRAWINGS">FIG. 143H</figref> illustrates that a first cement conduit can be inserted through the first delivery tube and into the first void segment. Bone cement can be delivered through the first cement conduit and into the first void segment.

<figref idref="DRAWINGS">FIG. 143<i>i </i></figref>illustrates that the first and second delivery tubes can be removed from the patient. The balloon void can be substantially filled with bone cement.

<figref idref="DRAWINGS">FIG. 144</figref> illustrates that a guide block <b>456</b> may have a surface block top surface <b>458</b><i>a </i>and a block bottom surface <b>458</b><i>b</i>. The block can have finger depressions <b>460</b> where a user's fingers may grip the block. The block <b>456</b> can have a curved block channel <b>464</b> passing though the block <b>456</b>. The block channel <b>464</b> can terminate at a block top hole <b>462</b><i>a </i>and a block bottom hole <b>462</b><i>b</i>. The block <b>456</b> can have one, two, or three radiopaque markers <b>466</b> evenly or unevenly distributed about the block <b>456</b>. The radiopaque markers <b>466</b> can have a fixed dimensional relationship to block bottom hole <b>462</b><i>b. </i>

The block can be partially or total radiolucent. The block top surface can be placed against a patient's back before a kyphoplasty procedure. The radiopaque markers can locate the block with respect to the patient anatomy. The block bottom hole can be located on the patient's back during use.

<figref idref="DRAWINGS">FIG. 145</figref> illustrates that an entry tool, such as a trocar <b>469</b> and a delivery tube, such as a cannula <b>468</b>, may have curvatures that substantially match the curvature of the block channel. The cannula <b>468</b> can slide freely in the block channel. The cannula can be lubricated on the outside diameter. The block top hole may be lubricated on the inside diameter. By holding block in place on the patient's anatomy, a medical practitioner may be able to advance the trocar and the cannula into a vertebral body along a curved arc.

<figref idref="DRAWINGS">FIG. 146</figref> illustrates that the cannula and trocar may advance further though the block. The trocar can be a torsion shaft with a drill bit on the distal end. Turning the torsion shaft can cause the drill to bore into bone while being guided in a curved path by the cannula.

The cannula can be a flexible tube or series of links. The cannula, for example as a tube, or series of links, may be steerable, for example similar to a catheter or an endoscope.

<figref idref="DRAWINGS">FIG. 147</figref> illustrates that the inflation system <b>470</b> can be attachable to a syringe <b>472</b> or other source of flow and pressure. The inflation system <b>470</b> can include part or all of the hollow shaft <b>2000</b>, an inner shaft <b>477</b><i>a</i>, a stiffening shaft <b>476</b>, a hollow shaft lumen <b>154</b>, a stiffening shaft lumen <b>478</b>, an inflation port <b>482</b> and a stiffening rod control <b>480</b>. The distal end of the stiffening shaft <b>476</b> can have a stiffening rod tip <b>484</b>.

The syringe <b>472</b> can be detachable or non-detachable from the remainder of the inflation system <b>470</b>. The balloon <b>20</b> may be inflated by pushing inflation fluid, such as water or dye, from the syringe <b>472</b>, into the inflation port <b>482</b>, through the hollow shaft lumen <b>154</b> and into the balloon <b>20</b>. The removable stiffening shaft <b>476</b> may be left in place to stiffen the inflation system <b>470</b> while positioning the balloon <b>20</b> in the body. Once the balloon <b>20</b> is in place, the removable shaft stiffener <b>476</b> can be removed to allow the hollow shaft <b>2000</b> additional freedom of motion outside the body.

The stiffening shaft <b>476</b> can be integral with or removably attached to the stiffening rod <b>474</b>. The stiffening rod tip <b>484</b> can have atraumatic geometry, or a soft plastic or elastomeric tip that will minimize puncture or damage the distal end of the balloon. The stiffener <b>476</b> can be withdrawn manually automatically.

<figref idref="DRAWINGS">FIG. 148</figref> illustrates that the inflation system <b>470</b> can have a balloon <b>20</b> that can be inflated by pushing inflation fluid, such as water, saline, a gel or dye, from the syringe <b>472</b>, into the inflation port <b>482</b>, though the hollow shaft lumen <b>154</b> and into the balloon <b>20</b>.

The stiffening rod <b>474</b> can be removed from the inflation system or left in place to stiffen the inflation system <b>470</b> while positioning the balloon <b>20</b> in the body. The inflation system can have a stiffening rod control <b>480</b>, for example a knob or handle on the proximal end of the inflation system to control the position of the stiffening rod. A seal adjacent to the stiffening rod control can prevent pressure from escaping from the hollow shaft lumen. When the balloon <b>20</b> is at the target site, the stiffening rod <b>474</b> can be removed from the inflation system or left in place.

<figref idref="DRAWINGS">FIG. 149</figref> illustrates that the stiffening rod control <b>480</b> can have inner threads <b>486</b><i>b</i>. A connector at the proximal end of the hollow shaft <b>2000</b> can have outer threads <b>486</b><i>a</i>. The stiffening rod control <b>480</b> can rotatably interface with the hollow shaft <b>2000</b> at the inner and outer threads <b>486</b><i>b </i>and <b>486</b><i>a. </i>

The stiffening rod <b>474</b> can be attached to the inside of the distal end of the balloon <b>20</b>. The stiffening rod can have a coupling (not shown) internal to the rod that can prevent the rod from applying torque to the balloon <b>20</b>. The stiffening rod can be made from flexible high strength filaments (not shown). The balloon <b>20</b> may be inflated by pushing inflation fluid, such as water or dye, from the syringe <b>472</b>, into an inflation port, though the hollow shaft lumen or inflation lumen and into the balloon. Turning the stiffening rod control knob may cause the balloon to longitudinally expand or contract. The balloon can evert when the stiffening rod is withdrawn proximally. The balloon's distal end may resemble the distal end <b>44</b> shown in <figref idref="DRAWINGS">FIG. 10</figref><i>d. </i>

<figref idref="DRAWINGS">FIG. 150A</figref> illustrates that the first balloon <b>20</b><i>a </i>can be inserted into the body through a working channel or delivery tube such as the cannula <b>468</b>. The first balloon <b>20</b><i>a </i>in a deflated configuration can be smaller in diameter than the cannula inner diameter <b>488</b>. The hollow shaft <b>2000</b> can have a hollow shaft outer diameter <b>490</b>. The hollow shaft outer diameter <b>490</b> can be smaller than the cannula inner diameter <b>488</b>. For example, the cannula inner diameter can be about 3.66 mm (0.144 in.). The hollow shaft outer diameter can be about 2 mm (0.09 in.), more narrowly about 1.5 mm (0.060 in.), yet more narrowly about 0.8 mm (0.03 in.). The stiffening rod can have a stiffener rod diameter. The stiffener rod can have a stiffening rod diameter <b>492</b>. The stiffener rod diameter can be about 1 mm (0.05 in.), or about 0.8 mm (0.03 in.), or about 0.5 mm (0.02 in.).

The first balloon <b>20</b><i>a </i>can be inflated in the body, for example creating a first balloon void, lumen or pocket in the body. The first balloon <b>20</b><i>a </i>can be inflated in bone. The first balloon <b>20</b><i>a </i>can be inflated in a vertebra of the spine. The first balloon <b>20</b><i>a </i>can then be deflated and pushed to the side of the cannula <b>468</b>.

<figref idref="DRAWINGS">FIG. 150E</figref> illustrates that a second balloon <b>20</b><i>b </i>can be inserted through the hollow shaft <b>2000</b> while the first balloon <b>20</b><i>a </i>is positioned through the hollow shaft <b>2000</b>. The first balloon <b>20</b><i>a </i>and the second balloon <b>20</b><i>b </i>can be inserted concurrently through the hollow shaft <b>2000</b>. The first balloon <b>20</b><i>a </i>can be deflated before the second balloon <b>20</b><i>b </i>is inflated.

<figref idref="DRAWINGS">FIG. 150C</figref> illustrates that the first balloon <b>20</b><i>a </i>and the second balloon <b>20</b><i>b </i>can be inserted into the initial void <b>442</b><i>a </i>created by a drill and/or the first balloon <b>20</b><i>a</i>. The first balloon <b>20</b><i>a </i>and the second balloon <b>20</b><i>b </i>can be inflated in the initial void <b>42</b><i>a</i>. The balloons <b>20</b> can create a final balloon void <b>442</b><i>b</i>, for example the final balloon void <b>442</b><i>b </i>can be larger than the initial balloon void <b>442</b><i>a</i>. Additional balloons can be inserted into the void <b>442</b> and inflated to further enlarge the balloon void <b>442</b>.

<figref idref="DRAWINGS">FIG. 151A</figref> illustrates that an inflation system <b>470</b> and the device <b>2</b> can create space in the body. The balloon <b>20</b> can be substantially compliant or substantially non-compliant. The hollow shaft <b>2000</b> can be attached to or integrated with the inflation system <b>470</b>.

The inflation system <b>470</b> can be portable and can be held in and operated by the user's hand. The inflation system <b>470</b> can provide a method for inflating the balloon <b>20</b>. The inflation system <b>470</b> can advance and retract the stiffening rod to stiffen the balloon <b>20</b> during insertion of the balloon <b>20</b> into the body. The hollow shaft <b>2000</b> can have an inflation lumen between the inflation system and the balloon <b>20</b>.

<figref idref="DRAWINGS">FIG. 151B</figref> illustrates that the inflation system <b>470</b> can have a pressure delivery body <b>498</b>, and a pressure control <b>494</b> (also element <b>590</b>) attached to the pressure delivery body <b>498</b>. The pressure control <b>494</b> can regulate the inflation of the balloon <b>20</b>. The inflation system <b>470</b> can have a stiffening rod control <b>480</b>. The stiffening rod control <b>480</b> can manipulate a stiffening rod <b>474</b> in the hollow shaft <b>2000</b>. For example, the stiffening rod <b>474</b> can be advanced through or retracted from the hollow shaft <b>2000</b>. The stiffening rod control <b>480</b> and/or the pressure control <b>494</b> can have buttons, knobs, or combinations thereof. The stiffening rod control <b>480</b> can be used to regulate the inflation of the balloon <b>20</b>. A pressure gauge <b>496</b> attached to the lumen can show the pressure in balloon <b>20</b>.

<figref idref="DRAWINGS">FIG. 151C</figref> illustrates that a pressure control interface <b>502</b> can interface the pressure delivery body <b>498</b> with the pressure control <b>494</b>. The pressure control interface <b>502</b> can be mating threads. The pressure control interface <b>502</b> can have male threads on the pressure control <b>494</b> that can mate to female threads on the pressure delivery body <b>498</b>.

Manipulating, such as turning, the pressure control interface <b>502</b>, can increase or decrease the pre-load volume. When the pressure control <b>494</b> closes on the pre-load volume <b>504</b>, the fluid in the pre-load volume <b>504</b> can exit through the pressure delivery body port <b>506</b> (also element <b>592</b>). The fluid in the pre-load volume <b>504</b> can have a water or a radiopaque dye.

The stiffening rod control <b>480</b> can have a stiffening rod control interface <b>500</b> can mate the stiffening rod control <b>480</b> with the pressure delivery body <b>498</b>. The stiffening rod control interface <b>500</b> can have mating threads. Turning the stiffening rod control <b>480</b> can extend and retract the stiffening rod <b>474</b>.

The pressure control interface <b>502</b> can have male threads on the pressure control <b>494</b> that can mate to female threads on the pressure delivery body <b>498</b>. The pressure control <b>494</b> and/or the stiffening rod control <b>480</b> can have one or more pressure tight seals to prevent leakage through the control.

<figref idref="DRAWINGS">FIG. 151C</figref> illustrates that the stiffening rod can block the pressure delivery body port <b>506</b> when the stiffening rod is in a longitudinally advanced position.

The o-ring seats <b>226</b> can seat o-rings that can seal against the pressure delivery body <b>498</b>. The seals <b>286</b> in o-ring seats <b>226</b> can form a pressurized volume between themselves that connects to the pressure delivery body port <b>506</b> and the input of pressure gauge <b>496</b> (as shown in <figref idref="DRAWINGS">FIGS. 151C and 151D</figref>). The seals <b>286</b> in the o-ring seats <b>226</b> can form a pressurized volume that does not always connect to the inflation lumen <b>154</b>. The inflation lumen <b>154</b> can connect to the internal volume of balloon <b>20</b>.

<figref idref="DRAWINGS">FIG. 151C</figref> illustrates that retracting the stiffening rod control <b>414</b> (e.g., unscrewing the stiffening rod control <b>414</b>) can cause the pressurized volume between seals <b>286</b> in o-ring seats <b>226</b> to no longer be in fluid communication with the inflation lumen, and/or the pressure delivery body port and/or the input of the pressure gauge <b>496</b>. The stiffening rod control <b>480</b> (by, for example, rotating it) may cause the pressure delivery body port <b>506</b> and the input of pressure gauge <b>496</b> to be connected to the inflation lumen <b>154</b> that leads to balloon <b>20</b>. Manipulating the pressure control <b>494</b> can cause fluid to flow though the pressure delivery body port <b>506</b>, through the inflation lumen <b>154</b> and into the balloon <b>20</b>, inflating the balloon <b>20</b>.

The distal end of the device <b>2</b>, for example the balloon <b>20</b>, can be inserted into the body though a cannula. The stiffening rod control can be manipulated to withdraw the stiffening member. The pressure control can be manipulated to move fluid from the pre-load volume <b>504</b> to the balloon volume.

Fluid entering the balloon <b>20</b> can cause the balloon <b>20</b> to inflate and create a balloon void in the body.

The pressure control <b>494</b> can be withdrawn from the pressure delivery body <b>498</b>. Fluid pressure can then move from the inside of balloon <b>20</b> back into pre-load volume <b>504</b>. The device <b>2</b> and inflation system <b>470</b> can then be withdrawn from the body.

The fluid that is transferred from pre-load volume <b>504</b> to the balloon volume can be sealed in the device before use, for example during manufacturing. The inflation system can have a fixed pre-load volume <b>504</b> before use, such that a user does not need to add fluid to the pre-load volume <b>504</b> during use. The inflation system can be sealed or otherwise designed to prevent fluid, other than fluid added to the pre-load volume <b>504</b> during manufacturing, from entering the pre-load volume <b>504</b>. The fluid in the pre-load volume <b>504</b> can be water, air, saline, radiopaque dye, a gel, or combinations thereof.

The volume of the pre-load volume <b>504</b> that can be delivered to the balloon volume can be set to inflate the balloon <b>20</b> to a pre-determined inflation size. The pre-load volume can be sealed when the inflating system is manufactured or fluid can be added or removed from the pre-load volume after manufacture of the inflation system and before use.

For example, the pre-load volume <b>504</b> or maximum volume deliverable to the balloon <b>20</b> (e.g., pre-load volume minus the volume of the pre-load lumen <b>508</b> and the volume of the hollow shaft) can be inflate the balloon <b>20</b> to a configuration where the one or more balloon walls <b>22</b> are strained less than 5%, for example less than 3%, also for example less than 1%.

The stiffening rod <b>474</b> can obstruct fluid from entering the balloon <b>20</b> from the pre-load volume <b>504</b> when the stiffening rod <b>474</b> is in a closed configuration. The stiffening rod <b>474</b> can not obstruct fluid from entering the balloon <b>20</b> from the pre-load volume <b>504</b> when the stiffening rod <b>474</b> is in an opened configuration. For example, the stiffening rod can be withdrawn from the remainder of the inflation system in the second configuration. The stiffening rod can be configured not to puncture the balloon <b>20</b> in the closed or opened configuration.

<figref idref="DRAWINGS">FIG. 151D</figref> illustrates that the stiffening rod <b>474</b> can be in the opened configuration. The pre-load volume can be in fluid communication with the balloon. The stiffening rod can not obstruct the pressure delivery body port.

<figref idref="DRAWINGS">FIGS. 152A through 152C</figref> illustrate that the stiffening rod control <b>480</b> can control fluid delivery to the balloon <b>20</b>. The stiffening rod control <b>480</b> can manipulate the stiffening rod. The stiffening rod control can retract proximally or extend distally the stiffening rod. The stiffening rod can extend longitudinally along the hollow shaft <b>2000</b>. The pressure gauge <b>496</b> can communicate the pressure in balloon <b>20</b> to the user. The balloon <b>20</b> can be substantially compliant or substantially non-compliant. The hollow shaft <b>2000</b> can have an inflation lumen extending between the inflation system and the balloon <b>20</b>.

<figref idref="DRAWINGS">FIG. 152C</figref> illustrates that the stiffening rod can have a stiffening rod interface <b>499</b> that can mate to the inside of the pressure delivery body, for example at screw threads (not shown). The stiffening rod control can have a pressure tight seal with the pre-load volume, such as at the o-ring seats. The stiffening rod control can be connected to or integral with the stiffening rod. Turning the stiffening rod control can extend and retract the stiffening rod. A pressure disk <b>510</b> can have one or more o-ring seats to form a pressure tight sliding seal with the pre-load volume and the stiffening rod. The pressure disk <b>510</b> can freely slide proximally and distally on the stiffening rod. A spring <b>514</b> can apply a force on the pressure disk <b>510</b> to push the pressure disk <b>510</b> distally. O-ring seats (with o-rings, not shown) along a stiffening rod step <b>512</b> can form a sealed and pressurized pre-load volume when the stiffening rod control is retracted.

The pressure delivery body port <b>506</b> can be obstructed by the stiffening rod step <b>512</b> when the stiffening rod is in a closed configuration, for example, distally extended within the inflation system. The pre-load volume and the pressure gauge can be in fluid isolation, for example by one or more o-rings in o-ring seats, from the balloon volume. The pre-load volume can be filled with air, water, saline, radiopaque dye, a gel, or combinations thereof.

<figref idref="DRAWINGS">FIG. 152D</figref> illustrates that when the stiffening rod control <b>480</b> is retracted (for example, rotating the control <b>480</b>), the stiffening rod can retract proximally within the inflation system into an opened configuration. The stiffening rod step can move proximally. The pressure delivery body port <b>506</b> can be in fluid communication with the balloon <b>20</b> and the pressure gauge. Proximally moving the stiffening rod control <b>480</b> can proximally move the pressure disk within the pre-load volume. The pressure disk can force fluid out of the pre-load volume, through the pressure delivery body port and into the balloon <b>20</b>. The pre-load volume can decrease in volume. The balloon can inflate.

When the balloon <b>20</b> is positioned at a target site to be treated, the stiffening rod control <b>480</b> can be rotated and/or retracted to proximally move the stiffening rod with respect to the pressure delivery body. The stiffening rod control and/or the pressure control can regulate the inflation of the balloon <b>20</b>, for example, by the fluid in the pre-load volume. The inflation and expansion of the balloon can create a void volume within in the body. The stiffening rod control and/or the pressure control can draw fluid from the balloon to the pre-load volume, deflating the balloon. The balloon can then be withdrawn from the target site.

The inflation system can be sealed to prevent fluid from the pre-load volume, or otherwise, from being delivered balloon volume until the stiffening rod has been proximally retracted (or distally extended, depending on the design).

<figref idref="DRAWINGS">FIG. 153</figref> illustrates that the stiffening rod <b>474</b> can have an atraumatic or blunt stiffening rod tip <b>484</b> and be anchored at the proximal end or base of the balloon <b>20</b>. Inflation fluid can enter and exit the balloon <b>20</b> through the lumen <b>154</b>. The length of the stiffening rod <b>474</b> is chosen such that when the balloon <b>20</b> is fully inflated, the blunt stiffening tip <b>484</b> will extend into the balloon volume, but not touch the inside of the balloon wall.

<figref idref="DRAWINGS">FIGS. 154A and 154B</figref> illustrate that a deployment sheath <b>516</b> can be placed circumferentially around a pleated balloon <b>20</b> in a contracted configuration. The sheath <b>516</b> can contain the balloon and prevent radial expansion of the balloon. The sheath can be retracted with respect to the balloon when the balloon is deployed through a cannula or into a target site. The sheath can have an open distal end. The distal end can have leaflets <b>518</b>. The balloon can be pushed through the leaflets <b>518</b> during deployment.

<figref idref="DRAWINGS">FIGS. 155A and 155B</figref> illustrates that the sheath can be placed around half of the balloon. The sheath can be placed around 180° of the balloon, as measured from the longitudinal axis. The balloon can exit from the distal end or lateral side of the sheath.

<figref idref="DRAWINGS">FIG. 156</figref> illustrates that the inflation system <b>470</b> can connect to the hollow shaft or tube <b>2000</b>. The hollow tube <b>2000</b> can be soft and flexible. The hollow tube <b>2000</b> can be permanently connected to the inflation system <b>470</b>. The inflation system can have a delivery syringe and/or pump. The hollow tube <b>2000</b> may have a fitting (not shown) that may allow it be disconnected from the inflation system.

The hollow tube <b>2000</b> can connect to a fitting. The fitting can connect to the balloon <b>20</b>. The balloon <b>20</b> is shown in a compacted condition such that it can moved though a tube and inserted in the body. The balloon volume can be in fluid communication with the inflation system, for example the pump.

The interior volumes of the tube the pump the balloon and the fitting may be filled with saline solution, radiopaque dye, a gel, air, distilled water, or combinations thereof during manufacture. The volume of fluid in the device <b>2</b> and the inflation system can be such that when the inflation system <b>470</b> has delivered a maximum output (i.e., all the fluid that can be delivered by the inflation system <b>470</b> has been delivered) of fluid to the balloon, the balloon can be substantially inflated to a maximum rated inflation size for the balloon. The inflation system can be sealed, for example to prevent addition or removal of fluid from the system except when used with the balloon <b>20</b>.

The inflation system can be configured to receive or evacuate excess fluid other than to the balloon. For example the inflation system can have a connector or valve for receiving or evacuating fluid.

The inflation system <b>470</b> and/or device <b>2</b> can be sealed under vacuum during manufacture. The balloon can be sealed under vacuum during manufacture. A membrane or soft plug can separate the inflation system from the hollow shaft and/or balloon before use. Raising the pressure in the inflation system can cause the membrane or plug to open and allow fluid into the balloon <b>20</b>.

<figref idref="DRAWINGS">FIG. 157</figref> illustrates that delivery rod or manipulation tool <b>520</b> can have a manipulation tool handle <b>528</b>. The manipulation tool <b>520</b> can have a manipulation tool shaft <b>522</b>. The manipulation tool <b>520</b> can have an interface fitting or clasp <b>526</b>. The manipulation tool shaft <b>522</b> can have a manipulation tool shaft diameter <b>524</b>. The manipulation tool shaft <b>522</b> can be solid or hollow. The manipulation tool shaft can be rigid or semi-rigid.

<figref idref="DRAWINGS">FIG. 158</figref> illustrates that the cannula <b>468</b> has been inserted to a target site within a body <b>530</b>. The cannula <b>468</b> can have an inner lumen that can act as a delivery passage to the target site. The balloon <b>20</b> can be inserted into cannula <b>468</b> by hand. The balloon <b>20</b> can fit tightly or snugly inside of the cannula <b>468</b>. A force parallel to the longitudinal axis of the cannula can be applied to advance the balloon <b>20</b> through the cannula. The hollow tube <b>2000</b> can be too flexible to reasonably deliver enough force to advance the balloon <b>2000</b> though the cannula.

<figref idref="DRAWINGS">FIG. 159</figref> illustrates that the clasp <b>526</b> on the manipulation tool <b>520</b> can interface with the fitting <b>594</b> so that the manipulation tool <b>520</b> can apply forces for maneuvering the balloon <b>20</b> outside and inside of the cannula <b>428</b>. The manipulation tool <b>520</b> can translate the balloon <b>20</b> longitudinally distal and/or proximal within the cannula. The manipulation tool <b>522</b> can rotate the balloon within the cannula.

<figref idref="DRAWINGS">FIGS. 160 and 161</figref> illustrate that the manipulation tool <b>520</b> can advance the balloon <b>20</b> partially into the cannula.

<figref idref="DRAWINGS">FIG. 162</figref> illustrates that the balloon <b>20</b> can be delivered to a target site in the body. The manipulation tool <b>520</b>, for example at the clasp <b>526</b>, can be removed from the fitting <b>594</b>. The hollow tube <b>2000</b> can be highly flexible. Wherein the hollow tube <b>2000</b> exits the cannula <b>468</b> the hollow tube can bend and lay substantially flat (as shown) on the top surface of the cannula <b>468</b>. The tube <b>2000</b> can not substantially obstruct the space directly above cannula <b>468</b>. The hollow tube <b>2000</b> can be rigid or floppy and buckle easily. When cantilevered out 2 cm, the hollow tube <b>2000</b> can deflect about 1 cm at less than about 0.015 N-m of torque, more narrowly at less than about 0.005 N-m of torque.

<figref idref="DRAWINGS">FIG. 163A</figref> illustrates that the fitting <b>594</b> can have a distal shaft interface. The distal shaft interface can have a hexagonal transverse cross-section. <figref idref="DRAWINGS">FIG. 163B</figref> illustrates that the driving rod or manipulation tool <b>520</b> can have a clasp <b>526</b> at the distal end of the manipulation tool shaft <b>522</b>. The interface fitting <b>594</b> can be configured to transmit force and torque through and removably attach to the clasp <b>526</b>. The clasp can have a hexagonal transverse cross-section or four sides of a hexagon. The clasp can have an open lateral side for the distal shaft fitting <b>594</b> to be inserted and removed.

<figref idref="DRAWINGS">FIG. 164A</figref> illustrates that the fitting <b>594</b> can have a square or rectangular cross-section. <figref idref="DRAWINGS">FIG. 164B</figref> illustrates that the clasp <b>526</b> can have a square or rectangular transverse cross-section or three sides of a square.

<figref idref="DRAWINGS">FIG. 165A</figref> illustrates that the fitting <b>594</b> can have a one or more or pins or pegs extending laterally. The fitting <b>594</b> can have a circular or oval cross-section. <figref idref="DRAWINGS">FIG. 165B</figref> illustrates that the clasp <b>526</b> can have one, two or more peg receivers. The distal shaft interface can have a circular, oval, partial circle, or partial oval transverse cross-section.

<figref idref="DRAWINGS">FIGS. 166A and 166B</figref> illustrate that the fitting <b>594</b> can have a circular shape with a projecting rectangular feature. The clasp <b>526</b> can have a female geometry that interfaces with rectangular feature of the fitting <b>594</b>. The clasp <b>526</b> can be semi-cylindrical.

<figref idref="DRAWINGS">FIG. 167</figref> illustrates that fitting <b>594</b> can be a circular fitting with a stop or longitudinal interference fitting element. The clasp <b>526</b> can have a cylindrical or hemi-cylindrical shape, for example that can encompass more than angularly half of the fitting <b>594</b>.

<figref idref="DRAWINGS">FIG. 168</figref> illustrates that interface <b>594</b> can be a male shear geometry. The clasp <b>526</b> can be a scissor-type device having two pivoting grasping jaws.

<figref idref="DRAWINGS">FIG. 169</figref> illustrates that interface <b>594</b> can have a male shear geometry. The clasp <b>526</b> can have a tweezer configuration having two resiliently bending jaws.

The clasp <b>526</b> may be able to pull, push or turn the fitting <b>594</b> through the cannula or at the target site.

<figref idref="DRAWINGS">FIG. 170</figref> illustrates that the manipulation tool <b>520</b> can have jaw arms <b>534</b><i>a </i>and <b>534</b><i>b</i>. The jaw arms can be parallel to each other and form a continuous U-shaped distal configuration of the manipulation tool. The interface <b>594</b> can have a male shear geometry that can mate with the geometry of the jaw arms <b>534</b> and/or the u-shaped configuration. The first jaw arms <b>534</b><i>a </i>can be rotationally attached to the second jaw arms <b>534</b><i>b </i>at a second pivot <b>532</b><i>b</i>. The manipulation tool first and second shafts <b>522</b><i>a </i>and <b>522</b><i>b </i>can be solid or hollow rigid rods or flexible cables. The manipulation tool first shaft <b>522</b><i>a </i>can be rotationally attached to the first jaw arm <b>534</b><i>a </i>at a first pivot <b>532</b><i>a</i>. Pulling the manipulation tool first shaft <b>522</b><i>a </i>with respect to the manipulation tool second shaft <b>522</b><i>b </i>can cause the outward rotation, as shown by arrow, of the first jaw arm <b>534</b><i>a</i>. This rotation can manipulate the position and orientation of the balloon <b>20</b>, and/or release the fitting <b>594</b> from the manipulation tool <b>520</b>.

<figref idref="DRAWINGS">FIG. 171A</figref> illustrates that the manipulation tool shaft <b>522</b> can have a tapered profile. <figref idref="DRAWINGS">FIG. 171B</figref> illustrates that the manipulation tool shaft <b>522</b> can have a circular profile. <figref idref="DRAWINGS">FIG. 171C</figref> illustrates that the manipulation tool shaft <b>522</b> can have an elliptical profile. <figref idref="DRAWINGS">FIG. 171D</figref> illustrates that the manipulation tool shaft <b>522</b> can have a rectangular profile. The corners of the rectangle may be rounded (not shown). <figref idref="DRAWINGS">FIG. 171E</figref> illustrates that the manipulation tool shaft <b>522</b> can have a hemispherical profile. <figref idref="DRAWINGS">FIG. 171F</figref> illustrates that the manipulation tool shaft <b>522</b> can have a hemispherical profile wherein the normally flat half of the surface can be convex. <figref idref="DRAWINGS">FIG. 171G</figref> illustrates that the manipulation tool shaft <b>522</b> can have a hemispherical profile wherein the normally flat half of the surface can be concave. <figref idref="DRAWINGS">FIGS. 171H and 171</figref><i>i </i>illustrate that the manipulation tool shaft <b>522</b> can be a portion of tube, for example 120° or 240° of the tube. The manipulation tool shaft <b>522</b> can be open on a lateral side. The manipulation tool shaft <b>522</b> can have stops, notches or threads to keep the manipulation tool from being inserted into the cannula past a certain length or allow the insertion into the cannula to happen at a controlled rate.

<figref idref="DRAWINGS">FIGS. 172A and 172B</figref> illustrate that the manipulation tool <b>520</b> can have a manipulation tool first shaft <b>522</b><i>a </i>radially inside a manipulation tool second shaft <b>522</b><i>b</i>. The manipulation tool first shaft can have preformed tangs <b>534</b><i>a </i>and <b>534</b><i>b </i>at the distal end of the manipulation tool first shaft. The distal end of the manipulation tool second shaft <b>5226</b> can have a notch <b>538</b> that can radially constrain the tangs <b>534</b>. The tangs <b>534</b><i>a </i>and <b>534</b><i>b </i>can be formed to spring radially outward when not constrained. When the manipulation tool second shaft is slid down toward the fitting <b>594</b>, the manipulation tool can press the tangs radially inward around the fitting, attaching the manipulation tool to the fitting. The fitting can be detached from the manipulation tool by sliding the manipulation tool second shaft away from the fitting. The manipulation tool can have a lateral shaft port <b>536</b> through which the hollow tube <b>2000</b> (not shown) can extend through and exit the manipulation tool.

<figref idref="DRAWINGS">FIGS. 173A and 173B</figref> show that the manipulation tool <b>522</b> can straight or curved. The curved manipulation tool shaft, shown in <figref idref="DRAWINGS">FIG. 173B</figref>, can be made of a super elastic material, such as Nitinol. The manipulation tool shaft can be straightened for insertion through the cannula, and curve after exiting the cannula <b>468</b>.

<figref idref="DRAWINGS">FIGS. 174A and 174B</figref> illustrate that the inflation system <b>470</b> can have a valve system <b>542</b>, a filled syringe <b>472</b>, a t-connector <b>540</b>, a cap <b>548</b> and a delivery pump or delivery syringe <b>588</b>. The valve system <b>542</b> can be attached to a first port <b>560</b><i>a </i>of the t-connector <b>540</b>. The delivery syringe <b>588</b> can be connected to a second port <b>560</b><i>b </i>of the t-connecter <b>540</b>. The cap <b>548</b> can be attached to the third port <b>550</b><i>c </i>of the t-connector.

The check valve can have a check spring <b>550</b> and a valve ball <b>552</b>. The swabbable valve can be attached to the filled syringe at a syringe interface <b>554</b>. The swabbable valve can be attached to the check valve at an intervalve interface <b>556</b>. The check valve can be attached to the t-connector at a first connector interface <b>558</b><i>a</i>. The delivery syringe can be attached to the t-connector at a second connector interface <b>558</b><i>b</i>. The cap can be attached to the t-connector at a third connector interface <b>558</b><i>c</i>. Any or all of the interfaces in the inflation system can be fixed or detachable connections, such as threaded connectors, luer connectors, glue, snap connectors, welds, or combinations thereof.

The valve system <b>542</b> can have a swabbable valve <b>544</b> connected to a check valve <b>546</b>. The check valve <b>546</b> can be configured to allow flow into the t-connector <b>540</b> and prevent flow out of the t-connector <b>540</b> through the valve system <b>542</b>.

A pre-filled syringe <b>472</b> of fluid can be attached to the valve system. The fluid can be a saline solution, a radiopaque solution, water, a gel, an epoxy or curable polymer, or combinations thereof. The fluid can be pushed through the swabbable valve <b>544</b> and the check valve <b>546</b> and into the delivery syringe <b>588</b>. The delivery syringe plunger can be pulled as the pre-filled syringe plunger is pushed.

After the fluid is delivered to the delivery syringe <b>588</b>, the cap <b>548</b> can be removed and a fluid conduit, such as the hollow shaft <b>2000</b>, can be attached to the t-connector third port <b>558</b><i>c </i>in place of the cap <b>548</b>. The fluid conduit <b>2000</b> can be positioned to have an output port at a target site, such as into the balloon <b>20</b> in a vertebral body. The delivery syringe plunger can be deployed, forcing fluid through the fluid conduit and to the target site. The balloon <b>20</b> can inflate, creating a void within cancellous bone at the target site. The check valve and swabbable valve can minimize or prevent flow to the pre-filled syringe during deployment of fluid from the delivery syringe to the fluid conduit. A manual valve does not need to be adjusted to direct the fluid to the fluid conduit.

<figref idref="DRAWINGS">FIG. 175</figref> illustrates that a kit can be packaged to contain a balloon <b>20</b>, driving rod or manipulation tool, fluid filled syringe <b>472</b>, delivery or inflation syringe <b>588</b>, or combinations thereof. The pre-filled syringe can be filled with the inflation fluid <b>586</b>. The kit can be in a sterile package. The balloon can have a flexible conduit, such as the hollow tube <b>2000</b>, attached to the first fluid port of the balloon <b>20</b>.

<figref idref="DRAWINGS">FIG. 176</figref> illustrates that the kit can have the balloon, driving rod, and the inflation syringe. The inflation syringe can be filled with a fluid such as saline solution, a radiopaque solution, water or combinations thereof. The kit can be in a sterile package.

<figref idref="DRAWINGS">FIG. 177</figref> illustrates that the kit can have the balloon, driving rod, and the inflation syringe. The balloon can be attached to and in fluid communication with a flexible tube. The flexible tube can be attached to and in fluid communication with the inflation syringe. The inflation syringe can be pre-filled with the inflation fluid <b>586</b>. The kit can be in a sterile package <b>584</b>.

<figref idref="DRAWINGS">FIG. 178</figref> shows a cross section of the heart <b>562</b>. The heart <b>562</b> has an aorta <b>568</b>, a left ventricle <b>570</b> and an aortic valve <b>564</b>

<figref idref="DRAWINGS">FIGS. 179A and 179B and 179C</figref> illustrate that a guidewire <b>572</b> can be inserted through the aorta <b>568</b> and positioned in the left ventricle <b>570</b> of the heart <b>562</b>. The device <b>2</b> can be slidably inserted over the guidewire through the aorta <b>568</b>. The device <b>2</b> may be in a deflated state when first placed in the aortic valve <b>564</b>. The device <b>2</b> can be positioned to align along the balloon longitudinal axis with the balloon with the aortic valve leaflets <b>566</b>. The device <b>2</b> can also be rotated about the balloon longitudinal axis to align with the aortic valve <b>564</b>, for example when cutting apart attached leaflets <b>566</b> in a bicuspid aortic valve with a flange, vane, blade, other cutting element described herein, or combinations thereof.

<figref idref="DRAWINGS">FIG. 179D</figref> shows the balloon <b>20</b> in an expanded configuration. The device <b>20</b> can be non-compliant and open the aortic valve <b>564</b> to a precise dimension (for example, about 20 mm or about 24 mm). The balloon <b>20</b> can fixedly reconfigure and press the aortic valve leaflets <b>566</b> against the outer wall or annulus <b>582</b> of the aortic valve <b>564</b>. The balloon <b>20</b> can radially expand the aortic valve annulus <b>582</b>.

The balloon can have an annular lumen <b>160</b>, as shown in <figref idref="DRAWINGS">FIGS. 36A through 40</figref>. Natural blood flow through the aortic valve can flow through the annular lumen <b>160</b> when the balloon is in an inflated or expanded configuration in the aortic valve. The device can have a device valve. The device valve can open and close, for example depending on the ventricular pressure against the device valve.

A radially expandable implant <b>156</b>, such as a stent, anchoring annulus or other component of a replacement heart valve, including the replacement valve, or combinations thereof, can be removably attached to the balloon before deployment. The balloon can deploy the radially expandable implant <b>156</b> in the aortic valve, for example at the annulus of the aortic valve. The balloon can deliver and deploy a percutaneous aortic valve at the aortic valve annulus.

<figref idref="DRAWINGS">FIG. 179E</figref> illustrates that the balloon can be deflated, contracted and withdrawn from the aortic valve.

<figref idref="DRAWINGS">FIG. 179F</figref> shows the aortic valve in an opened configuration at a larger dimension than before the procedure.

The method described supra can be performed on an aortic, mitral, pulmonary, tricuspid or vascular valve.

<figref idref="DRAWINGS">FIG. 180A</figref> illustrates that the balloon can be positioned in a narrowed, atherosclerotic length of a blood vessel <b>574</b> having atherosclerotic plaque <b>576</b> on the interior of the vessel wall <b>578</b>. The vessel <b>574</b> can have a vessel lumen <b>580</b> through which blood can flow.

<figref idref="DRAWINGS">FIG. 180B</figref> illustrates that the balloon <b>20</b> can be inflated and expanded. The balloon <b>20</b> can remodel the vessel, pushing the sclerotic plaque radially away from the balloon longitudinal axis. The balloon <b>20</b> can deploy a vascular stent to the sclerotic length of the vessel.

<figref idref="DRAWINGS">FIG. 180C</figref> illustrates that the balloon <b>20</b> can be deflated, contracted and removed from the narrowed length of the vessel <b>574</b>. The vessel lumen <b>574</b> can remain patent after the balloon is removed, for example restoring blood flow past the treated atherosclerotic length.

The balloon <b>20</b> can be implanted in the body semi-permanently or permanently. The balloon <b>20</b> can have one, two or more openings for fluid entry and/or exit.

Any elements described herein as singular can be pluralized (i.e., anything described as “one” can be more than one), and plural elements can be used individually. Any species element of a genus element can have the characteristics or elements of any other species element of that genus. The term “comprising” is not meant to be limiting. The above-described configurations, elements or complete assemblies and methods and their elements for carrying out the invention, and variations of aspects of the invention can be combined and modified with each other in any combination.